Provider Demographics
NPI:1336183581
Name:METHODIST ASSOCIATES IN HEALTHCARE GYN
Entity Type:Organization
Organization Name:METHODIST ASSOCIATES IN HEALTHCARE GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, CONTRACTING
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:PO BOX 828937
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8937
Mailing Address - Country:US
Mailing Address - Phone:215-503-1240
Mailing Address - Fax:215-463-2540
Practice Address - Street 1:2301 S BROAD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3542
Practice Address - Country:US
Practice Address - Phone:215-952-5175
Practice Address - Fax:215-463-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA595136Medicare ID - Type Unspecified