MEDICARE: PHILADELPHIA HOSPITAL ASSOCIATIONS

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	261Q00000X	Clinic/Center		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085951	OTHER	PA	AETNA US HEALTHCARE
2	085951	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1881726164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA HOSPITAL ASSOCIATIONS

Provider Business Mailing Address
First Line	:	3001 WALNUT ST
Second Line	:	4TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3414
Country	:	US
Telephone Number	:	215-386-3556
Fax Number	:	267-295-1604

Provider Business Practice Location Address
First Line	:	3001 WALNUT ST
Second Line	:	4TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3414
Country	:	US
Telephone Number	:	215-386-3556
Fax Number	:	267-295-1604

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. CARL GRAHAM
Credential	:
Telephone Number	:	215-386-3556

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	08/11/2008

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