Healthcare Provider Details

I. General information

NPI: 1396003620
Provider Name (Legal Business Name): URBAN HEALTH INITIATIVES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 S BROAD ST STE 300
PHILADELPHIA PA
19146-4808
US

IV. Provider business mailing address

1408 S BROAD ST STE 300
PHILADELPHIA PA
19146-4808
US

V. Phone/Fax

Practice location:
  • Phone: 215-755-0700
  • Fax: 215-755-6487
Mailing address:
  • Phone: 215-755-0700
  • Fax: 215-755-6487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KOBIE T. WEST
Title or Position: CEO
Credential:
Phone: 215-755-0700