BUSTLETON HEALTHCARE; NPI #1588107668

Contact Information

BUSTLETON HEALTHCARE

9867 BUSTLETON AVE
SUITE B
PHILADELPHIA, PA 19115-2611

Phone: 215-698-9295
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Primary Care	261QP2300X
Medical Specialty	261QM2500X

Indicates primary specialty

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NPI Profile & details for BUSTLETON HEALTHCARE

NPI # 1588107668

LBN Legal business name BUSTLETON HEALTHCARE

Authorized official IRINA JOUKOVA - (PRESIDENT)

Entity Organization

Organization subpart ¹ Yes

Enumeration date 11/22/2016

Last updated 11/22/2016 - About 10 years ago

Identifiers

PA	License #	MD 435017
PA	Medicaid	102790572 0001

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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