Provider Demographics
NPI:1134297393
Name:METHODIST HOSPITAL
Entity Type:Organization
Organization Name:METHODIST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-955-9895
Mailing Address - Street 1:PO BOX 85009895
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-955-7106
Mailing Address - Fax:215-955-8732
Practice Address - Street 1:2301 SOUTH BROAD
Practice Address - Street 2:BROAD AND WOLF STREETS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145
Practice Address - Country:US
Practice Address - Phone:215-955-7106
Practice Address - Fax:215-955-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA200801282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001021000OtherBLUE CROSS
PA1007571300061Medicaid
PA6490945OtherAETNA PPO
PA0001461OtherAETNA
PA390174OtherCBH
PA390174OtherUNITED HEALTH CARE