Provider Demographics
NPI:1750445110
Name:PRESBYTERIAN MEDICAL CENTER OF THE UNIV OF PA HEALTH SYSTEM
Entity Type:Organization
Organization Name:PRESBYTERIAN MEDICAL CENTER OF THE UNIV OF PA HEALTH SYSTEM
Other - Org Name:UPHS PRESBYTERIAN MEDICAL CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-762-0888
Mailing Address - Street 1:1500 MARKET ST
Mailing Address - Street 2:UM600
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2100
Mailing Address - Country:US
Mailing Address - Phone:215-762-0630
Mailing Address - Fax:215-762-0754
Practice Address - Street 1:51 N 39TH ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-762-0630
Practice Address - Fax:215-762-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA392358Medicare ID - Type UnspecifiedPRESBYTERIAN MEDICAL RENA