MEDICARE: SPECTRUM HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265866107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	5201 HAVERFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-1401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 HAVERFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-1401
Country	:	US
Telephone Number	:	215-472-6095
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	VERONICA HILL-MILBLBOURNE
Credential	:
Telephone Number	:	215-472-3240

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	05/19/2026

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