Provider Demographics
NPI:1154645299
Name:KENNEDY UNIVERSITY HOSPITAL, INC
Entity Type:Organization
Organization Name:KENNEDY UNIVERSITY HOSPITAL, INC
Other - Org Name:KENNEDY OB GYN ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-557-5555
Mailing Address - Street 1:445 HURFVILLE - CROSSKEYS RD.
Mailing Address - Street 2:BUILDING A
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:856-557-5555
Mailing Address - Fax:856-218-2873
Practice Address - Street 1:445 HURFFVILLE CROSSKEYS RD BLDG A
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2337
Practice Address - Country:US
Practice Address - Phone:856-557-5555
Practice Address - Fax:856-218-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center