Provider Demographics
NPI:1982650594
Name:WJO INC.
Entity Type:Organization
Organization Name:WJO INC.
Other - Org Name:BUSTLETON FAMILY PRACTICE AND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-757-0465
Mailing Address - Street 1:424 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-4813
Mailing Address - Country:US
Mailing Address - Phone:215-826-8050
Mailing Address - Fax:215-826-8053
Practice Address - Street 1:9600 ROOSEVELT BLVD.
Practice Address - Street 2:SUITE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115
Practice Address - Country:US
Practice Address - Phone:215-826-8050
Practice Address - Fax:215-826-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1675135OtherHIGHMARK
PA2351050000OtherPERSONAL CHOICE
PA087766Medicare ID - Type Unspecified