MEDICARE: COURAGE MEDICINE HEALTH CENTER 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	207Q00000X	Family Medicine Physician
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1841845369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURAGE MEDICINE HEALTH CENTER INC.

Provider Business Mailing Address
First Line	:	7198 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1105
Country	:	US
Telephone Number	:	267-217-3217
Fax Number	:	267-459-8942

Provider Business Practice Location Address
First Line	:	7198 CASTOR AVE STE 200
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1105
Country	:	US
Telephone Number	:	267-217-3217
Fax Number	:	267-459-8942

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	TRISHA L ACRI
Credential	:	MD
Telephone Number	:	267-217-3217

Provider Enumeration Date	:	08/02/2019
Last Update Date	:	11/16/2022

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