Organization
JEFFERSON MEDICAL CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HRISTOS RISTAS (VICE PRESIDENT)
(215) 955-9298
Entity
Organization
Contact information
Practice address
211 S 9TH ST, SUITE 305, PHILADELPHIA, PA 19107-6810
(215) 955-9558
(215) 955-3920
Mailing address
PO BOX 828937, PHILADELPHIA, PA 19182-8937
(215) 955-1240
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016886700001
—
PA
Enumeration date
10/12/2006
Last updated
10/14/2022
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