Provider Demographics
NPI:1346357399
Name:7622 MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:7622 MEDICAL CENTER, INC.
Other - Org Name:ALLIED MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINCOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-893-4700
Mailing Address - Street 1:7622 OGONTZ AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1817
Mailing Address - Country:US
Mailing Address - Phone:215-893-4700
Mailing Address - Fax:215-893-4704
Practice Address - Street 1:7622 OGONTZ AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1817
Practice Address - Country:US
Practice Address - Phone:215-893-4700
Practice Address - Fax:215-893-4704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:7622 MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-24
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA627816Medicare PIN