Provider Demographics
NPI:1902841018
Name:TPS III OF PA, LLC
Entity Type:Organization
Organization Name:TPS III OF PA, LLC
Other - Org Name:HAHNEMANN PRIMARY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:PO BOX 827794
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7794
Mailing Address - Country:US
Mailing Address - Phone:215-546-5000
Mailing Address - Fax:215-546-6100
Practice Address - Street 1:231 N BROAD ST
Practice Address - Street 2:1ST, FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1511
Practice Address - Country:US
Practice Address - Phone:215-557-0212
Practice Address - Fax:215-557-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
076974Medicare PIN