Provider Demographics
NPI:1588669261
Name:ASSOCIATED MEDICAL SPECIALTIES, INC.
Entity Type:Organization
Organization Name:ASSOCIATED MEDICAL SPECIALTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:I
Authorized Official - Last Name:BALABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-677-4486
Mailing Address - Street 1:2901 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1208
Mailing Address - Country:US
Mailing Address - Phone:215-677-4486
Mailing Address - Fax:215-677-3644
Practice Address - Street 1:2901 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19154-1208
Practice Address - Country:US
Practice Address - Phone:215-677-4486
Practice Address - Fax:215-677-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8000000475332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008755420002Medicaid
2671433OtherAETNA-HMO
PA60430Medicaid
NJ3532909Medicaid
NJ60430Medicaid
5986470OtherAETNA-PPO
PA0875542Medicaid
202886OtherPREMIER BLUE
202886OtherPERSONAL CHOICE
2598000OtherKEYSTONE HEALTH PLAN EAST
NJ1000514900Medicaid
PA0008755420002Medicaid