Provider Demographics
NPI:1619043882
Name:HEALTH ASSOCIATES OF SOUTH PHILADELLPHIA
Entity Type:Organization
Organization Name:HEALTH ASSOCIATES OF SOUTH PHILADELLPHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOBLE
Authorized Official - Middle Name:SIDNEY
Authorized Official - Last Name:JONESA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-755-0700
Mailing Address - Street 1:1408 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4808
Mailing Address - Country:US
Mailing Address - Phone:215-755-0700
Mailing Address - Fax:215-755-6474
Practice Address - Street 1:1408 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-4808
Practice Address - Country:US
Practice Address - Phone:215-755-0700
Practice Address - Fax:215-755-6474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA725709Medicare ID - Type Unspecified