Provider Demographics
NPI:1043212137
Name:PMA MEDICAL SPECIALISTS
Entity Type:Organization
Organization Name:PMA MEDICAL SPECIALISTS
Other - Org Name:PRIME HEALTH NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:RIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-933-8000
Mailing Address - Street 1:450 PARK WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-4202
Mailing Address - Country:US
Mailing Address - Phone:484-422-8080
Mailing Address - Fax:484-422-8073
Practice Address - Street 1:450 PARK WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-4202
Practice Address - Country:US
Practice Address - Phone:484-422-8080
Practice Address - Fax:484-422-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA789590207Q00000X, 207R00000X
PAPT024201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACA4343OtherRAILROAD MEDICARE
PACC4778OtherRAILROAD MEDICARE
PACA2851OtherRAILROAD MEDICARE
PACI1897OtherRAILROAD MEDICARE
PACC5809OtherRAILROAD MEDICARE
PA0007049930005Medicaid
PACD5679OtherRAILROAD MEDICARE
PACC5809OtherRAILROAD MEDICARE