Healthcare Provider Details

I. General information

NPI: 1306285176
Provider Name (Legal Business Name): PUBLIC HEALTH MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 N FRONT ST
PHILA PA
19120-2719
US

IV. Provider business mailing address

1500 MARKET ST LM 500 WEST TOWER
PHILA PA
19102-2100
US

V. Phone/Fax

Practice location:
  • Phone: 215-279-9666
  • Fax: 215-279-9674
Mailing address:
  • Phone: 215-985-2500
  • Fax: 267-765-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. FRANK KILLIAN
Title or Position: DIRECTOR-OPERATIONS
Credential:
Phone: 215-985-2514