Provider Demographics
NPI:1114029592
Name:HEALTH SERVICES OF FOX CHASE CANCER CENTER
Entity Type:Organization
Organization Name:HEALTH SERVICES OF FOX CHASE CANCER CENTER
Other - Org Name:PAIN MANAGEMENT ASSOCIATES OF FCCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-214-1490
Mailing Address - Street 1:333 COTTMAN AVENUE
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111
Mailing Address - Country:US
Mailing Address - Phone:215-728-6900
Mailing Address - Fax:215-728-3593
Practice Address - Street 1:333 COTTMAN AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-728-6900
Practice Address - Fax:215-728-3593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208VP0000X
PA012901284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No284300000XHospitalsSpecial HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012467940074Medicaid
PA151634Medicare PIN