Healthcare Provider Details

I. General information

NPI: 1881779866
Provider Name (Legal Business Name): PUBLIC HEALTH MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 215-985-2514
  • Fax: 267-765-2325
Mailing address:
  • Phone: 215-985-2514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: FRANK KILLIAN
Title or Position: DIR. OF FINANCE AND REG. AFFAIRS
Credential:
Phone: 215-985-2514