MEDICARE: NAZARETH PHYSICIAN SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	658619	OTHER	PA	AETNA OFFICE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2457876002	OTHER	PA	IBC#
4	NA1775677	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1356377550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAZARETH PHYSICIAN SERVICES INC

Provider Business Mailing Address
First Line	:	1 W ELM ST
Second Line	:	SUITE 100
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2007
Country	:	US
Telephone Number	:	610-567-6967
Fax Number	:	610-567-6170

Provider Business Practice Location Address
First Line	:	7044 TORRESDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-1915
Country	:	US
Telephone Number	:	215-332-7772
Fax Number	:	215-332-2547

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOHN J KIRBY
Credential	:
Telephone Number	:	215-335-6614

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	04/09/2008

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Directions to “NAZARETH PHYSICIAN SERVICES INC ” Practice Location

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