Provider Demographics
NPI:1912477324
Name:JEFFERSON UNIVERSITY PHYSCIANS
Entity Type:Organization
Organization Name:JEFFERSON UNIVERSITY PHYSCIANS
Other - Org Name:JEFFERSON PRIMARY CARE AT THE NAVY YARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOC DIRECTOR OF ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:BRIGHT-BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-955-9457
Mailing Address - Street 1:PO BOX 828937
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8937
Mailing Address - Country:US
Mailing Address - Phone:215-503-1240
Mailing Address - Fax:
Practice Address - Street 1:3 CRESCENT DR FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1016
Practice Address - Country:US
Practice Address - Phone:215-503-3210
Practice Address - Fax:215-503-7136
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON UNIVERSITY PHYSCIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-28
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty