Basic Information
| Provider Information | |||||||||
| NPI: | 1053456079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIA HEALTH PHYSICIANS SERVICES - EMERGENCY MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 825395 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191825395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158078000 | ||||||||
| FaxNumber: | 2156124532 | ||||||||
| Practice Location | |||||||||
| Address1: | 3998 RED LION RD | ||||||||
| Address2: | EMERGENCY MEDICINE | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191141436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156124963 | ||||||||
| FaxNumber: | 2156124532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | FINN | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2157103757 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | PA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AM0700X | PA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 207P00000X | PA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 07645 | 01 | PA | HEALTH PARTNERS | OTHER | 363705 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1090244 | 01 | PA | KEYSTONE MERCY | OTHER | 1007526250039 | 05 | PA | MEDICAID | 1017694 | 01 | PA | KEYSTONE MERCY | OTHER | 1007526250041 | 05 | PA | MEDICAID | 363705 | 01 | PA | PERSONAL CHOICE | OTHER | 0730941000 | 01 | PA | KEYSTONE,IBC | OTHER | 30035894 | 01 | PA | KEYSTONE MERCY | OTHER | 452729 | 01 | PA | AETNA CONTRACT | OTHER | 1007526250051 | 05 | PA | MEDICAID |