Healthcare Provider Details

I. General information

NPI: 1689620171
Provider Name (Legal Business Name): GREATER PHILADELPHIA HEALTH ACTION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 N. 6TH STREET
PHILADELPHIA PA
19123-4004
US

IV. Provider business mailing address

1401 S. 31ST STREET 2ND FLOOR
PHILADELPHIA PA
19146-3506
US

V. Phone/Fax

Practice location:
  • Phone: 215-627-8000
  • Fax: 215-627-9265
Mailing address:
  • Phone: 215-925-2400
  • Fax: 215-925-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL
# 9
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. D TINA SMITH
Title or Position: PROVIDER ENROLLMENT SPEC.
Credential:
Phone: 215-925-2400