Provider Demographics
NPI:1518366517
Name:CORE PERFORMANCE PHYSICIANS, LLC
Entity Type:Organization
Organization Name:CORE PERFORMANCE PHYSICIANS, LLC
Other - Org Name:VINCERA CORE PHYSICIANS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-592-3200
Mailing Address - Street 1:1200 CONSTITUTION AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19112-1329
Mailing Address - Country:US
Mailing Address - Phone:267-592-3200
Mailing Address - Fax:888-393-3980
Practice Address - Street 1:1200 CONSTITUTION AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1329
Practice Address - Country:US
Practice Address - Phone:267-592-3200
Practice Address - Fax:888-393-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty