Provider Demographics
NPI:1720131485
Name:THE NEMOURS FOUNDATION
Entity Type:Organization
Organization Name:THE NEMOURS FOUNDATION
Other - Org Name:NEMOURS DUPONT PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKENDREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-697-5628
Mailing Address - Street 1:PO BOX 404112
Mailing Address - Street 2:C/O MANAGED CARE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4112
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-697-5630
Practice Address - Street 1:2500 ENGLISH CREEK AVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5549
Practice Address - Country:US
Practice Address - Phone:609-641-3700
Practice Address - Fax:302-651-4549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE NEMOURS FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072420OtherMEDICARE GROUP NUMBER
NJ5030129Medicaid