Provider Demographics
NPI:1700823663
Name:SPAETH KATZ & MYER PC
Entity Type:Organization
Organization Name:SPAETH KATZ & MYER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCATTERGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-928-3239
Mailing Address - Street 1:840 WALNUT STREET
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-928-3197
Mailing Address - Fax:215-928-0166
Practice Address - Street 1:840 WALNUT STREET
Practice Address - Street 2:SUITE 1110
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-928-3197
Practice Address - Fax:215-928-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0089125000OtherKEYSTONE EAST, AMERIHEALT
PA99388OtherAETNA
PA48553OtherKEYSTONE MERCY
PA0011495670014Medicaid
PA174104Medicare PIN
PA99388OtherAETNA