Provider Demographics
NPI:1639554991
Name:INSPIRA HEALTH MANAGEMENT
Entity Type:Organization
Organization Name:INSPIRA HEALTH MANAGEMENT
Other - Org Name:IMG, PATHOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, AMBULATORY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ARUTHUR
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-641-8627
Mailing Address - Street 1:2848 S DELSEA DR STE 4B
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7042
Mailing Address - Country:US
Mailing Address - Phone:856-205-7070
Mailing Address - Fax:
Practice Address - Street 1:509 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1617
Practice Address - Country:US
Practice Address - Phone:856-205-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06071600207ZP0102X
TXL9076207ZP0102X
NJ25MA03874500207ZP0102X
PAMT192156207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH51891Medicare UPIN
342604V79Medicare PIN
I40495Medicare UPIN
365860V79Medicare PIN
342770V79Medicare PIN
343179V79Medicare PIN