Healthcare Provider Details

I. General information

NPI: 1649825795
Provider Name (Legal Business Name): METHODIST ASSOCIATES IN HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S 10TH ST
PHILADELPHIA PA
19107-5244
US

IV. Provider business mailing address

PO BOX 828937
PHILADELPHIA PA
19182-8937
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8900
  • Fax: 215-923-3447
Mailing address:
  • Phone: 215-503-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN PADGETT
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 215-955-1175