Provider Demographics
NPI:1851370910
Name:TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Entity Type:Organization
Organization Name:TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Other - Org Name:HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:215-762-0888
Mailing Address - Street 1:1500 MARKET ST
Mailing Address - Street 2:UPPER MEZZANINE 600
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2100
Mailing Address - Country:US
Mailing Address - Phone:215-796-4640
Mailing Address - Fax:609-770-7792
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-796-4640
Practice Address - Fax:609-770-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QM0801X, 273R00000X, 276400000X, 282N00000X, 3416L0300X
PA261QA0006X, 3416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No251S00000XAgenciesCommunity/Behavioral Health
No261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No273R00000XHospital UnitsPsychiatric Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001258770069Medicaid
NJ4193105Medicaid
NJ4193105Medicaid