Provider Demographics
NPI:1033575352
Name:METHODIST ASSOCIATES IN HEALTHCARE, INC.
Entity Type:Organization
Organization Name:METHODIST ASSOCIATES IN HEALTHCARE, INC.
Other - Org Name:JEFFERSON COMMUNITY PHYSICIANS - KAIRYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOC. VP, HEALTH PLAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:HRISTOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RISTAS
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:
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:2016-01-04
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty