Provider Demographics
NPI:1205954856
Name:IMMEDIATE MEDICAL CARE OF PENNSYLVANIA, LP
Entity type:Organization
Organization Name:IMMEDIATE MEDICAL CARE OF PENNSYLVANIA, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRILLIANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-459-3278
Mailing Address - Street 1:1572 WILMINGTON PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8317
Mailing Address - Country:US
Mailing Address - Phone:610-459-3278
Mailing Address - Fax:610-459-8642
Practice Address - Street 1:1572 WILMINGTON PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8317
Practice Address - Country:US
Practice Address - Phone:610-459-3278
Practice Address - Fax:610-459-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018877650001Medicaid
PA1953751OtherBLUE SHIELD
PA2833384000OtherINDEPENDENCE BLUE CROSS
PA1953751OtherBLUE SHIELD