Provider Demographics
NPI:1558011338
Name:METHODIST ASSOCIATES IN HEALTH CARE, INC
Entity Type:Organization
Organization Name:METHODIST ASSOCIATES IN HEALTH CARE, INC
Other - Org Name:JEFFERSON COMMUNITY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-955-1175
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 1:1513 RACE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1125
Practice Address - Country:US
Practice Address - Phone:215-587-3406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty