Organization · Type 2 NPI

Dedicated Pennsylvania Holding, LLC

Specialist · Philadelphia, PA

NPI number 1477053569 Active

Practice location

6431 Sackett St
Philadelphia, PA 19149-3118

Call (305) 628-6117 Map

Fax (305) 363-5989

Mailing address

1395 N.w/ 167th Street, Payer Enrollment Department
Miami Gardens, FL 33169

Specialties and licenses

Taxonomy	Code	License
Specialist Primary	174400000X	None listed
Internal Medicine Physician	207R00000X	None listed
Primary Care Clinic/Center	261QP2300X	None listed
Non-Pharmacy Dispensing Site	332900000X	None listed

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

10 other providers at this address

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NPI record

NPI: 1477053569
Entity type: Organization (Type 2)
Issued: Feb 15, 2018
Last updated: Mar 27, 2018
Status: Active
Subpart: Yes of Dedicated Pennsylvania Mayfair

Other names

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Dedicated Pennsylvania Mayfair · doing business as
Dedicated Pennsylvania Mayfair · doing business as

Authorized official

Mr. Raymond Jimenez
Director of Client Services
(786) 870-4039

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1477053569

Dedicated Pennsylvania Holding, LLC's National Provider Identifier is 1477053569, issued on Feb 15, 2018. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Philadelphia, PA. The record was last updated on Mar 27, 2018.