Provider Demographics
NPI:1467514794
Name:GENERAL PRACTICE INC
Entity Type:Organization
Organization Name:GENERAL PRACTICE INC
Other - Org Name:ST VINCENT MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:RODOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-763-9564
Mailing Address - Street 1:703 CECIL B MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19122
Mailing Address - Country:US
Mailing Address - Phone:215-763-9564
Mailing Address - Fax:215-763-1165
Practice Address - Street 1:703 CECIL B MOORE AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19122
Practice Address - Country:US
Practice Address - Phone:215-763-9564
Practice Address - Fax:215-763-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
041759GGJOtherPHYSICIAN MEDICARE
ST177626Medicare ID - Type UnspecifiedGROUP