PENNCARE-J. EDWIN WOOD CLINIC (NPI# 1104967918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104967918 |
| Entity Type | Organization |
| Organization Name | PENNCARE-J. EDWIN WOOD CLINIC |
| Practice Address |
700 Spruce St 304 Philadelphia PA 19106-4022 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 2158293532 |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2012-12-04 |
| Authorized Official Name | KENNY HEINE (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 8586252990 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | OS012672 | PA | Suppliers |
| Street Address |
700 SPRUCE ST 304 |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19106-4022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982698619 | Stephen M. Goldman | Ophthalmology | 700 Spruce St, Suite 100, Philadelphia, PA 19106-4022 | 2005-09-08 |
| 1669995668 | Adrianne Wells | Registered Nurse | 700 Spruce St, Duncan Building Suite B3, Philadelphia, NJ 19104-1910 | 2017-07-21 |
| 1366999419 | Margaret Miklich | Pharmacist | 700 Spruce St, Suite 304, Philadelphia, PA 19106-4022 | 2016-09-07 |
| 1346614831 | Timothy Roberts | Physician Assistant | 700 Spruce St, Pine Basement West, Philadelphia, PA 19106-4022 | 2015-11-20 |
| 1912377276 | Ian Majczan | Physician Assistant | 700 Spruce St, Pine Basement West, Philadelphia, PA 19106-4022 | 2015-09-30 |
| 1073983441 | Jordan Scheurer Reed | Emergency Medicine | 700 Spruce St, Philadelphia, PA 19106 | 2015-09-29 |
| 1467870477 | Gregory N Wallingford | Emergency Medicine | 700 Spruce St, Pine Basement West, Philadelphia, PA 19106-4022 | 2014-04-07 |
| 1497099766 | Christina Kay Gehman | Physician Assistant | 700 Spruce St, Philadelphia, PA 19106 | 2012-11-26 |
| 1720339419 | Sherri A Hansell | Physician Assistant | 700 Spruce St, Pine Basement West, Philadelphia, PA 19106-4022 | 2012-09-21 |
| 1245580067 | Kathryn M Doshi | Physician Assistant | 700 Spruce St, Pine Basement West, Philadelphia, PA 19106-4022 | 2012-09-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841807245 | Jaclyn Isis Lisberger | Speech-Language Pathologist | 130 North 2nd Street-#2e, Philadelphia, PA 19106 | 2020-09-29 |
| 1356964159 | Michelle Copija | Nurse Anesthetist, Certified Registered | Society Hill Anesthesia Consultants, P.C., 301 S. 8th St Suite 2l, Philadelphia, PA 19106 | 2020-05-27 |
| 1811468929 | Old City Orthodontics LLC | Clinic/Center | 14 S 3rd Street, 1st Floor, Philadelphia, PA 19106 | 2018-12-16 |
| 1437627569 | Peter James Voystock | Social Worker | Veterans' Multi-service Center, 2nd Floor, 213-217 N 4th St, Philadelphia, PA 19106 | 2018-11-07 |
| 1467975334 | Aasiyah's Inc | Nurse's Aide | 325-41 Chestnut Street Suite 800, Suite 800, Philadelphia, PA 19106 | 2017-07-21 |
| 1457883043 | Jackie Kurland | Registered Nurse | 301 S 8th St Ste 2l, Philadelphia, PA 19106 | 2017-04-01 |
| 1669851655 | Amy Hardenbergh | Nurse Anesthetist, Certified Registered | 325 Chestnut Street, Suite 210, Society Hill Anesthesia Consultants, Philadelphia, PA 19106 | 2015-05-22 |
| 1790178820 | Bita Khoshrou | Dentist | 604 S Washington Square, Philadelphia, PA 19106 | 2015-03-13 |
| 1144667262 | Krystal Maloni | Surgery | 700 Spruce St Ste 101, Philadelphia, PA 19106 | 2013-05-30 |
| 1487099305 | Aimee E Wood | Social Worker | 233 South 6th St, Suite C33, Philadelphia, PA 19106 | 2013-05-06 |
| Find all providers in zip 19106 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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|---|---|---|---|---|
| 1023655602 | Dedicated Pennsylvania Holding, LLC | Non-Pharmacy Dispensing Site | 330 W Oregon Ave # 170, Philadelphia, PA 19148-4723 | 2019-12-03 |
| 1134528839 | Bucks Philadelphia Medical Care Group | Non-Pharmacy Dispensing Site | 10745 Haldeman Ave, Philadelphia, PA 19116-3928 | 2014-08-19 |
| 1376843912 | Philadelphia Chemocap Hair Store | Non-Pharmacy Dispensing Site | 766 S 4th St, Philadelphia, PA 19147-3137 | 2010-10-29 |
| 1326185182 | Morrell Eye Care, Inc. | Non-Pharmacy Dispensing Site | 3810 Morrell Ave, Philadelphia, PA 19114-1915 | 2007-01-31 |
| 1588738017 | David L Topolsky Md | Non-Pharmacy Dispensing Site | 230 S Broad St, 15th Flr, Philadelphia, PA 19102-4121 | 2006-11-17 |
| 1356828123 | Richard H. Kaplan, M.d., P.C. | Non-Pharmacy Dispensing Site | 9140 Academy Rd Ste A, Philadelphia, PA 19114-2853 | 2018-07-25 |
| 1407397565 | Premier Pain & Rehab Center | Non-Pharmacy Dispensing Site | 10184 Verree Rd, Philadelphia, PA 19116-3637 | 2017-03-09 |
| 1336699776 | Anand Medical Investment | Non-Pharmacy Dispensing Site | 5000 Frankford Ave, Suite 2, Philadelphia, PA 19124-2620 | 2016-10-10 |
| 1780926915 | Alliance Cancer Specialists,p.c. | Non-Pharmacy Dispensing Site | 3998 Red Lion Rd, Suite 130, Philadelphia, PA 19114-1445 | 2013-03-26 |
| 1679844492 | Alliance Cancer Specialists, P.C. | Non-Pharmacy Dispensing Site | 3998 Red Lion Rd, Suite 130, Philadelphia, PA 19114-1445 | 2012-01-25 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19106 |
Please comment or provide details below to improve the information on PENNCARE-J. EDWIN WOOD CLINIC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.