OrganizationIndepedence Medical Associates P.C.Family MedicineAllopathic & Osteopathic PhysiciansPractice Address3790 Morrell Ave, Philadelphia, PA 19114-1955(215) 612-1450PECOS EnrollmentBased on the most recent information from CMS, provider Indepedence Medical Associates P.C. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:30 AM.Profile DetailsProvider ID1053348953Provider TypeOrganizationFull NameIndepedence Medical Associates P.C.SubpartNoEnumeration Date6/27/2006Last Updated10/27/2008Contact InformationPractice LocationPractice Address3790 Morrell Ave, Philadelphia, PA 19114-1955Phone(215) 612-1450Fax(215) 612-1420Mailing LocationMailing Address3790 Morrell Ave, Philadelphia, PA 19114-1955Phone(215) 612-1450Fax(215) 612-1420Authorized OfficialNameGlickman, Jay (Physician)Phone(215) 612-1450Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseOS 009194-LPennsylvaniaProvider IdentifiersIDDescriptionIssuerID2222546001DescriptionOtherIssuerKEYSTONE HMO IDPennsylvania