CITYLIFE-PA, PC (NPI# 1285010801) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285010801 |
| Entity Type | Organization |
| Organization Name | CITYLIFE-PA, PC |
| Practice Address |
3945 Chestnut St 2nd Floor Philadelphia PA 19104-3621 |
| Mailing Address |
2020 21st Ave S Suite 202 Nashville TN 37212-4354 |
| Practice Telephone | 2678191800 |
| Mailing Telephone | 6157084487 |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2015-08-05 |
| Authorized Official Name | WILLIAM BRADLEY ROUSE (EVP) |
| Authorized Official Telephone | 6157084487 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| Street Address |
3945 CHESTNUT ST 2ND FLOOR |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19104-3621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609121482 | Ryan Dominic Menezes | Dentist | 3945 Chestnut St, Apt 907, Philadelphia, PA 19104-3621 | 2012-07-18 |
| 1528420056 | Hyeon Hwangbo | Dentist | 3945 Chestnut St, Apt 405, Philadelphia, PA 19104-3621 | 2016-03-23 |
| 1700243805 | Jaime Brown | Registered Nurse | 3945 Chestnut St, Philadelphia, PA 19104-3621 | 2016-01-20 |
| 1760865711 | Ampersand Health-pa, LLC | Clinic/Center | 3945 Chestnut St, Second Floor, Philadelphia, PA 19104-3621 | 2015-07-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639770829 | Michelle Morris | Student in an Organized Health Care Education/Training Program | Dept. of Family Medicine & Community Health, 3737 Market, Philadelphia, PA 19104 | 2020-11-04 |
| 1346853041 | Spectrum Health Services, Inc. | Clinic/Center | 1415 South University Ave, Philadelphia, PA 19104 | 2020-08-24 |
| 1770104259 | Fatimah Sorefan-mangou | Student in an Organized Health Care Education/Training Program | 4 Maloney 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1114548690 | Rebecca Blaguski | Registered Nurse | The Hospital of The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1952944175 | Rebecca Miriam Barmherzig | Psychiatry & Neurology | 3501 Civic Centre Blvd, 10th Flr Ctrb, Neurology, Philadelphia, PA 19104 | 2019-10-21 |
| 1891257101 | James Paul Byrne | Surgery | Penn Presbyterian Medical Center, Division of Trauma, S, 51 N. 39th Street, Suite 120, 1st Floor Medical Office, Philadelphia, PA 19104 | 2019-04-04 |
| 1093276453 | Lauren Shreve | Student in an Organized Health Care Education/Training Program | Department of Surgery, Surgery Education - Penn Health, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104 | 2019-03-28 |
| 1285194282 | Lauren M Christie | Student in an Organized Health Care Education/Training Program | Penn Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104 | 2019-03-25 |
| 1114487683 | Sabrina Layne | Student in an Organized Health Care Education/Training Program | 3400 Spruce Street, 100 Centrex, Philadelphia, PA 19104 | 2019-03-21 |
| 1811457310 | Kia Lor | Student in an Organized Health Care Education/Training Program | Hospital of University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 | 2019-03-21 |
| Find all providers in zip 19104 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124642996 | Wound Pros Medical Group | General Practice | 1500 Market Street 12th Floor, East Tower, Philadelphia, PA 19102-2152 | 2020-06-08 |
| 1831755735 | Good Hope Health Center Corp | General Practice | 7712 Buist Ave, Philadelphia, PA 19153-1705 | 2019-05-15 |
| 1366008260 | Ltc Treatment Center Inc | General Practice | 7712 Buist Ave Apt B, Philadelphia, PA 19153-1705 | 2019-05-15 |
| 1972072288 | Paula Alejandra Pino Pommer | General Practice | 3551 North Broad St., Philadelphia, PA 19140-4160 | 2018-11-15 |
| 1689183121 | Gem Wound Specialists, LLC | General Practice | 250 N Columbus Blvd Apt 707, Philadelphia, PA 19106-1458 | 2017-09-27 |
| 1023556875 | Bralow Medical Group | General Practice | 834 South St., Philadelphia, PA 19147 | 2017-02-01 |
| 1790135358 | Jeffrey Anthony Gazzara Jr. | General Practice | 621, 1515 Market Street, Suite 1200, Philadelphia, PA 19102-1921 | 2016-06-14 |
| 1053788240 | J. Todd Willis, Md Clinic | General Practice | 1003 Holland Avenue, Suite 104, Philadelphia, MS 39350-2180 | 2015-08-24 |
| 1225411655 | Brian Michael Lauer | General Practice | 609 E Passyunk Ave Apt 2, Philadelphia, PA 19147-1530 | 2015-07-02 |
| 1003294588 | Health Hero Pa LLC | General Practice | 217 Dickinson St, Philadelphia, PA 19147-6003 | 2015-05-15 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19104 |
Please comment or provide details below to improve the information on CITYLIFE-PA, PC.
| 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.