Provider Demographics
NPI:1023048717
Name:TENET HEALTHSYSTEM GRADUATE, LLC
Entity type:Organization
Organization Name:TENET HEALTHSYSTEM GRADUATE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-436-2267
Mailing Address - Street 1:PO BOX 828120
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8120
Mailing Address - Country:US
Mailing Address - Phone:215-255-3152
Mailing Address - Fax:215-893-2302
Practice Address - Street 1:1800 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-8400
Practice Address - Country:US
Practice Address - Phone:215-893-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QA1903X
PA073001282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000418OtherHUMANA
15624OtherHEALTH PARTNERS
X000483602OtherAMERICHOICE NEW JERSEY
NY01999637Medicaid
PA1001275950006Medicaid
INGRA0285NMedicaid
DE1000017120Medicaid
SC11038AMedicaid
VT0390285Medicaid
PA1001275950004Medicaid
DC37137100Medicaid
SC11233BMedicaid
2309OtherINDEPENDENCE BLUE CROSS
NC3900285Medicaid
MD9517502 00Medicaid
000841822OtherAETNA US HEALTHCARE
VA010055148Medicaid
60009OtherKEYSTONE MERCY HEALTH PLA
NJ802-9709Medicaid
VT0390285Medicaid