Provider Demographics
NPI:1417415258
Name:METHODIST ASSOCIATES IN HEALTHCARE, INC.
Entity Type:Organization
Organization Name:METHODIST ASSOCIATES IN HEALTHCARE, INC.
Other - Org Name:JEFFERSON COMMUNITY PHYSICIANS - UROGYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
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 1:833 CHESTNUT ST FRNT 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4420
Practice Address - Country:US
Practice Address - Phone:215-955-5000
Practice Address - Fax:215-923-1089
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHODIST ASSOCIATES IN HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-12
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty