Provider Demographics
NPI:1134127426
Name:DELAWARE VALLEY MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:DELAWARE VALLEY MEDICAL MANAGEMENT
Other - Org Name:DELAWARE VALLEY ORTHOPEDIC AND SPINE SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-949-7132
Mailing Address - Street 1:100 PRESIDENTIAL BLVD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1108
Mailing Address - Country:US
Mailing Address - Phone:610-664-2122
Mailing Address - Fax:610-664-2315
Practice Address - Street 1:100 PRESIDENTIAL BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1108
Practice Address - Country:US
Practice Address - Phone:610-664-2122
Practice Address - Fax:610-664-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA01161501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001596000OtherIBC
PA060767OtherWORKER'S COMPENSATION
PA060767OtherMOTOR VEHICLE
PA0077845390002Medicaid
PA10586OtherELDER HEALTH
PA2969665OtherAETNA
PA30016469OtherKEYSTONE MERCY
PA35243OtherHEALTH PARTNERS
PA=========OtherTRICARE
PA2969665OtherAETNA
PA=========OtherDEVON
PA=========OtherUNITED HEALTHCARE
PA0077845390002Medicaid
PA0077845390002Medicaid