Provider Demographics
NPI:1689704298
Name:HEALTH SERVICES OF FOX CHASE CANCER CENTER
Entity Type:Organization
Organization Name:HEALTH SERVICES OF FOX CHASE CANCER CENTER
Other - Org Name:PAIN MANAGEMENT ASSOC. OF FCCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JANNOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-214-1405
Mailing Address - Street 1:333 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2434
Mailing Address - Country:US
Mailing Address - Phone:215-214-1405
Mailing Address - Fax:215-728-3593
Practice Address - Street 1:333 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2434
Practice Address - Country:US
Practice Address - Phone:215-214-1405
Practice Address - Fax:215-728-3593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA151634Medicare ID - Type Unspecified