Provider Demographics
NPI:1023447398
Name:METHODIST ASSOCIATES IN HEALTHCARE, INC
Entity type:Organization
Organization Name:METHODIST ASSOCIATES IN HEALTHCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHT-BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-955-9457
Mailing Address - Street 1:1101 MARK STREET
Mailing Address - Street 2:30TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4495
Mailing Address - Country:US
Mailing Address - Phone:215-955-9457
Mailing Address - Fax:
Practice Address - Street 1:3 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1016
Practice Address - Country:US
Practice Address - Phone:215-503-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007729870101Medicaid
PA1007729870101Medicaid