Provider Demographics
NPI: | 1710987417 |
---|---|
Name: | CHS PROFESSIONAL PRACTICE, INC |
Entity Type: | Organization |
Organization Name: | CHS PROFESSIONAL PRACTICE, INC |
Other - Org Name: | COORDINATED HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT & CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | EMIL |
Authorized Official - Middle Name: | JOHN |
Authorized Official - Last Name: | DIIORIO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 610-861-8080 |
Mailing Address - Street 1: | 2775 SCHOENERSVILLE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | BETHLEHEM |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 18017-7307 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-861-8080 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2775 SCHOENERSVILLE RD |
Practice Address - Street 2: | |
Practice Address - City: | BETHLEHEM |
Practice Address - State: | PA |
Practice Address - Zip Code: | 18017-7307 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-861-8080 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-07-26 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | 111N00000X, 207K00000X, 207L00000X, 207RR0500X, 207X00000X, 207XS0106X, 207XS0117X, 208100000X, 208200000X, 2082S0105X, 2085R0202X, 213ES0103X, 225100000X, 225X00000X, 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
No | 2082S0105X | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 001715070 | Medicaid | |
PA | 685984 | Medicare PIN |