Organization
JEFFERSON UNIVERSITY PHYSICIANS
Active
Other names
Family Medicine - Senior Center
Organization subpart
No
Provider details
NPI number
Authorized official
HRISTOS RISTAS (VP OF PROVIDER OPERATIONS)
(215) 955-9298
Entity
Organization
Contact information
Practice address
33 S 9TH ST, PHILADELPHIA, PA 19107-4408
(215) 955-6664
Mailing address
1101 MARKET ST FL 30, PHILADELPHIA, PA 19107-2934
(215) 955-1175
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060238007
INDEPENDENCE BLUE CROSS
PA
01
—
2977562
AETNA
PA
01
—
30025703
KEYSTONE MERCY
PA
Enumeration date
04/18/2008
Last updated
12/13/2020
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