Healthcare Provider Details

I. General information

NPI: 1073531240
Provider Name (Legal Business Name): PHMC CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 GIRARD AVENUE
PHILADELPHIA PA
19130
US

IV. Provider business mailing address

1600 GIRARD AVENUE
PHILADELPHIA PA
19130
US

V. Phone/Fax

Practice location:
  • Phone: 215-787-9617
  • Fax: 215-787-9615
Mailing address:
  • Phone: 215-787-9617
  • Fax: 215-787-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD COHEN
Title or Position: PRESIDENT
Credential: PHD
Phone: 215-985-2546