Provider Demographics
NPI:1366819799
Name:PRIME HEALTHCARE SERVICES-SUBURBAN HOSPITAL LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES-SUBURBAN HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4307
Mailing Address - Street 1:2701 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1820
Mailing Address - Country:US
Mailing Address - Phone:610-278-2000
Mailing Address - Fax:610-272-4642
Practice Address - Street 1:2701 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1820
Practice Address - Country:US
Practice Address - Phone:610-278-2000
Practice Address - Fax:610-272-4642
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE SERVICES-SUBURBAN HOSPITAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-02
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA197201261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100727702Medicaid
PA103075750Medicaid
PA390116Medicare Oscar/Certification