Healthcare Provider Details

I. General information

NPI: 1922570498
Provider Name (Legal Business Name): METHODIST ASSOCIATES IN HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CRESCENT DR FL 2
PHILADELPHIA PA
19112-1016
US

IV. Provider business mailing address

PO BOX 828937
PHILADELPHIA PA
19182-8937
US

V. Phone/Fax

Practice location:
  • Phone: 215-503-7090
  • Fax: 215-503-3210
Mailing address:
  • Phone: 215-503-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: VALERIE YVETTE BRIGHT-BUTLER
Title or Position: ASSOCIATE DIRECTOR, CREDENTIALING
Credential:
Phone: 215-955-9451