Provider Demographics
NPI:1487884243
Name:PENNSYLVANIA PSYCHIATRIC INSTITUTE - OUTPATIENT SERVICES
Entity type:Organization
Organization Name:PENNSYLVANIA PSYCHIATRIC INSTITUTE - OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-782-4742
Mailing Address - Street 1:PO BOX 826929
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-6929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2501 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1904
Practice Address - Country:US
Practice Address - Phone:717-782-6420
Practice Address - Fax:717-782-2351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENNSYLVANIA PSYCHIATRIC INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-15
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
283Q00000X
PA325481283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
394051Medicare Oscar/Certification