Basic Information
| Provider Information | |||||||||
| NPI: | 1417415258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METHODIST ASSOCIATES IN HEALTHCARE, INC. | ||||||||
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| OtherOrganizationName: | JEFFERSON COMMUNITY PHYSICIANS - UROGYNECOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 828937 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191828937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155031240 | ||||||||
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| Practice Location | |||||||||
| Address1: | 833 CHESTNUT ST FRNT 1 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159555000 | ||||||||
| FaxNumber: | 2159231089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2019 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | RISTAS | ||||||||
| AuthorizedOfficialFirstName: | HRISTOS | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 2159559298 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | METHODIST ASSOCIATES IN HEALTHCARE, INC. | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VF0040X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
No ID Information.