1316072077 NPI number — ARIA HEALTH PHYSICIAN SERVICES

Table of content: (NPI 1316072077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316072077 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:
1316072077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 825395
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:
19182-5395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-671-8900
Provider Business Mailing Address Fax Number:
215-671-1272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9501 ROOSEVELT BLVD
Provider Second Line Business Practice Location Address:
SUITE 206-B
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114-1025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-671-8900
Provider Business Practice Location Address Fax Number:
215-671-1272
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KUMOR
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
215-612-4858

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1007526250039 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007526250051 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10236 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007526250041 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1026492 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 19933 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 379777 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 379777 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0200976001 . This is a "KEYSTONE, IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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