Healthcare Provider Details

I. General information

NPI: 1902267230
Provider Name (Legal Business Name): METHODIST ASSOCIATES IN HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S BROAD ST
PHILADELPHIA PA
19148-3542
US

IV. Provider business mailing address

PO BOX 828937
PHILADELPHIA PA
19182-8937
US

V. Phone/Fax

Practice location:
  • Phone: 215-952-9936
  • Fax: 215-952-1247
Mailing address:
  • Phone: 215-503-1240
  • Fax: 215-952-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: HRISTAS RISTOS
Title or Position: VP OF CONTRACTING
Credential:
Phone: 215-955-9298