Provider Demographics
NPI:1336455336
Name:THE INJURY CARE CENTER
Entity Type:Organization
Organization Name:THE INJURY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:AIKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-494-5601
Mailing Address - Street 1:901 W. ASHLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036
Mailing Address - Country:US
Mailing Address - Phone:484-494-5601
Mailing Address - Fax:484-494-6463
Practice Address - Street 1:901 W. ASHLAND AVE.
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036
Practice Address - Country:US
Practice Address - Phone:484-494-5601
Practice Address - Fax:484-494-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA568787YDMTMedicare PIN
PADR1713Medicare PIN
PA201464Medicare PIN