Provider Demographics
NPI:1902267230
Name:METHODIST ASSOCIATES IN HEALTHCARE, INC.
Entity Type:Organization
Organization Name:METHODIST ASSOCIATES IN HEALTHCARE, INC.
Other - Org Name:JEFFERSON COMMUNITY PHYSICIANS-NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:HRISTAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RISTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-955-9298
Mailing Address - Street 1:PO BOX 828937
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8937
Mailing Address - Country:US
Mailing Address - Phone:215-503-1240
Mailing Address - Fax:215-952-1247
Practice Address - Street 1:2301 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3542
Practice Address - Country:US
Practice Address - Phone:215-952-9936
Practice Address - Fax:215-952-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty