Provider Demographics
NPI:1700314853
Name:VIA AFFILIATES
Entity Type:Organization
Organization Name:VIA AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-345-2389
Mailing Address - Street 1:PO BOX 892641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-9641
Mailing Address - Country:US
Mailing Address - Phone:215-933-0259
Mailing Address - Fax:215-933-3672
Practice Address - Street 1:4259 W SWAMP RD STE 108
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-1033
Practice Address - Country:US
Practice Address - Phone:267-370-5296
Practice Address - Fax:215-230-3861
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOYLESTOWN HEALTH URGENT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-01
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care