Provider Demographics
NPI:1548379993
Name:UNIV OF PENN - HYPERBARIC
Entity Type:Organization
Organization Name:UNIV OF PENN - HYPERBARIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-662-7583
Mailing Address - Street 1:3620 HAMILTON WALK
Mailing Address - Street 2:1 JOHN MORGAN BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4215
Mailing Address - Country:US
Mailing Address - Phone:215-898-9095
Mailing Address - Fax:
Practice Address - Street 1:3620 HAMILTON WALK
Practice Address - Street 2:1 JOHN MORGAN BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4215
Practice Address - Country:US
Practice Address - Phone:215-898-9095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207PE0005X, 207PH0002X, 207RP1001X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07417OtherHEALTHPARTNERS
PA147708OtherBLUE SHIELD
NJ3485013Medicaid
PA487202200OtherACS
PA0016106680Medicaid
PA0054421000OtherKEYSTONE
PA32901OtherAETNA
PACF8179OtherRR MEDICARE
PA273291OtherMAMSI
PA0002Y21654OtherHEALTHNET
PA1008376OtherMERCY
PA203664OtherEEIOC
PA273291OtherMAMSI