1104014042 NPI number — ARIA HEALTH PHYSICIAN SERVICES

Table of content: (NPI 1104014042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104014042 NPI number — ARIA HEALTH PHYSICIAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIA HEALTH PHYSICIAN SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104014042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500-6335
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-807-8000
Provider Business Mailing Address Fax Number:
215-464-6522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9892 BUSTLETON AVE
Provider Second Line Business Practice Location Address:
MOSS PLAZA - SUITE 206
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19115-2184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-673-0343
Provider Business Practice Location Address Fax Number:
215-464-6522
Provider Enumeration Date:
10/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABRAHAM
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-612-4823

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007526250039 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007526250041 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1413853 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2952901 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01749 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2101721000 . This is a "KEYSTONE,IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007526250051 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30001994 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007526250050 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1413853 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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