Healthcare Provider Details

I. General information

NPI: 1124555909
Provider Name (Legal Business Name): PUBLIC HEALTH MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 PARKSIDE AVE
PHILADELPHIA PA
19104-1020
US

IV. Provider business mailing address

1500 MARKET ST LM 500 WEST TOWER ATTN: D. PRITCHARD/SHS
PHILADELPHIA PA
19102-2100
US

V. Phone/Fax

Practice location:
  • Phone: 215-871-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DOROTHY PRITCHARD
Title or Position: ADMIN./CREDENTIALING COORDINATOR
Credential:
Phone: 215-985-2595