Provider Demographics
NPI:1639343890
Name:JEFFERSON UNIVERSITY PHYSICIANS
Entity Type:Organization
Organization Name:JEFFERSON UNIVERSITY PHYSICIANS
Other - Org Name:UROLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF NETWORK OPERATIONS
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 1:1101 MARKET ST FL 30
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2934
Mailing Address - Country:US
Mailing Address - Phone:215-955-1175
Mailing Address - Fax:
Practice Address - Street 1:33 S 9TH ST STE 703
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4408
Practice Address - Country:US
Practice Address - Phone:215-955-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2370033000OtherAMERIHEALTH
NJ7548109Medicaid
PA120728OtherAETNA
PA32944OtherKEYSTONE MERCY
PA0445135000OtherINDEPENDENCE BLUE CROSS
PA959635OtherHIGHMARK BLUE SHIELD