Provider Demographics
NPI:1750328001
Name:JAMES L. TWEEDY D.O. & ASSOCIATES P.C.
Entity Type:Organization
Organization Name:JAMES L. TWEEDY D.O. & ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:TWEEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-334-6762
Mailing Address - Street 1:724 W PORTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3841
Mailing Address - Country:US
Mailing Address - Phone:215-334-6762
Mailing Address - Fax:215-271-2338
Practice Address - Street 1:724 W PORTER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3841
Practice Address - Country:US
Practice Address - Phone:215-334-6762
Practice Address - Fax:215-271-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00704456Medicaid
PA0273261001OtherBLUE SHIELD
PA00704456Medicaid