Provider Demographics
NPI:1881726164
Name:PHILADELPHIA HOSPITAL ASSOCIATIONS
Entity type:Organization
Organization Name:PHILADELPHIA HOSPITAL ASSOCIATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-386-3556
Mailing Address - Street 1:3001 WALNUT ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3414
Mailing Address - Country:US
Mailing Address - Phone:215-386-3556
Mailing Address - Fax:267-295-1604
Practice Address - Street 1:3001 WALNUT ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3414
Practice Address - Country:US
Practice Address - Phone:215-386-3556
Practice Address - Fax:267-295-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085951OtherAETNA US HEALTHCARE
PA085951OtherAETNA