Basic Information
| Provider Information | |||||||||
| NPI: | 1023033792 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENET HEALTH SYSTEM HAHNEMANN, LLC | ||||||||
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| OtherOrganizationName: | HAHNEMANN UNIVERSITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 741230 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303741230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152553152 | ||||||||
| FaxNumber: | 2157628109 | ||||||||
| Practice Location | |||||||||
| Address1: | BROAD & VINE STREETS | ||||||||
| Address2: | MAILSTOP 417 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157627000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | ARMIN | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF GOVT PROGRAMS, TENET | ||||||||
| AuthorizedOfficialTelephone: | 8184362267 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | N | Hospitals | General Acute Care Hospital | Critical Access | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QA1903X | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 282N00000X | 081701 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0002304 | 01 | INDEPENDENCE BLUE CROSS | OTHER | 010045720 | 05 | VA | MEDICAID | 10362A | 05 | SC | MEDICAID | 8029300 | 05 | NJ | MEDICAID | 000402332 | 01 | AETNA US HEALTHCARE (NATI | OTHER | 3900290 | 05 | NC | MEDICAID | 911341000 | 05 | FL | MEDICAID | 2304 | 01 | AMERIHEALTH INC. | OTHER | 765124400 | 05 | MD | MEDICAID | 0000977805 | 05 | DE | MEDICAID | 00014 | 01 | HEALTH PARTNERS | OTHER | 01570779 | 05 | KY | MEDICAID | 019387700 | 05 | DC | MEDICAID | 0199655 | 05 | NY | MEDICAID | 0316250 | 05 | OH | MEDICAID | HOS00290N | 05 | AL | MEDICAID | 000419 | 01 | HUMANA | OTHER | XPHSP32790 | 05 | CA | MEDICAID |