BROAD STREET PROFESSIONAL MEDICAL SERVICES LLC NPI 1720630650

NPI Information

NPI: 1720630650
Provider Name: BROAD STREET PROFESSIONAL MEDICAL SERVICES LLC
Classification: Surgery - 2086S0129X
Entity Type: Organization

Specialization: Vascular Surgery

Address:
2033 S BROAD ST STE A
PHILADELPHIA, PA
ZIP 19148
Phone: (215) 795-3855
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BROAD STREET PROFESSIONAL MEDICAL SERVICES LLC is a vascular surgery surgery in Philadelphia, PA. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. BROAD STREET PROFESSIONAL MEDICAL SERVICES LLC NPI is 1720630650. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2033 S BROAD ST STE A
PHILADELPHIA, PA
ZIP 19148-505
Phone: (215) 795-3855
Fax: (224) 235-4652

The provider's authorized official is Ami Almeda .
The authorized official title is Credentialing Manager and has the following contact phone number (224) 318-0118.

The enumeration date for this NPI number is 7/11/2019 and was last updated on 7/11/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0129X	Surgery	Vascular Surgery			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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