DEDICATED PENNSYLVANIA HOLDING LLC NPI 1477053569

NPI Information

  • NPI: 1477053569
  • Provider Name: DEDICATED PENNSYLVANIA HOLDING, LLC
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • Doing Business As: DEDICATED PENNSYLVANIA MAYFAIR
  • CLIA Number: 39D2149677
  • Address: 6431 SACKETT ST
    PHILADELPHIA, PA
    ZIP 19149
  • Phone: (305) 628-6117

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NPI Details

DEDICATED PENNSYLVANIA HOLDING, LLC is a specialist in Philadelphia, PA. The provider is 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. DEDICATED PENNSYLVANIA HOLDING, LLC NPI is 1477053569. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Dedicated Pennsylvania Mayfair.

The provider's business location address is:

6431 SACKETT ST
PHILADELPHIA, PA
ZIP 19149-118
Phone: (305) 628-6117
Fax: (305) 363-5989

The provider's authorized official is Raymond Jimenez .
The authorized official title is Director Of Client Services and has the following contact phone number (786) 870-4039.

The CLIA number assigned to this NPI record is 39D2149677 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/15/2018 and was last updated on 3/27/2018.

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
1174400000XSpecialistYes
2207R00000XInternal MedicineNo
3261QP2300XClinic/CenterPrimary CareNo
4332900000XNon-Pharmacy Dispensing SiteNo

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: 11/21/2025

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