Provider Demographics
NPI:1508031287
Name:JEFFERSON UNIVERSITY PHYSCIANS
Entity Type:Organization
Organization Name:JEFFERSON UNIVERSITY PHYSCIANS
Other - Org Name:ANESTHESIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNKEYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-955-2562
Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:SUITE 630
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:215-955-0800
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT ST
Practice Address - Street 2:SUITE 630
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4414
Practice Address - Country:US
Practice Address - Phone:215-955-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0510573000OtherINDEPENDENCE BLUE CROSS
NJ7633301Medicaid
PA31568OtherAETNA
PA33013OtherKEYSTONE MERCY
PA559586OtherHIGHMARK BLUE SHIELD