Provider Demographics
NPI:1477929727
Name:LIFECARE PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:LIFECARE PHYSICIANS, P.C.
Other - Org Name:LIFECARE GI PHYSICIANS P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-599-5036
Mailing Address - Street 1:500 GROVE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1761
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:856-796-9397
Practice Address - Street 1:2275 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 6 &7
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-2643
Practice Address - Country:US
Practice Address - Phone:609-890-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFECARE PHYSICIANS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty