Basic Information
| Provider Information | |||||||||
| NPI: | 1023447398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METHODIST ASSOCIATES IN HEALTHCARE, INC | ||||||||
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| OtherOrganizationName: | JEFF INTERNAL MEDICINE AT NAVY YARD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 MARK STREET | ||||||||
| Address2: | 30TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159559457 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3 CRESCENT DR | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191121016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155033300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2013 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRIGHT-BUTLER | ||||||||
| AuthorizedOfficialFirstName: | VALERIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2159559457 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1007729870101 | 05 | PA | MEDICAID |