Healthcare Provider Details

I. General information

NPI: 1235653080
Provider Name (Legal Business Name): GREATER PHILADELPHIA HEALTH ACTION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DICKINSON STREET
PHILADELPHIA PA
19146-9733
US

IV. Provider business mailing address

1401 S 31ST ST FL 2
PHILADELPHIA PA
19146-3506
US

V. Phone/Fax

Practice location:
  • Phone: 215-220-9002
  • Fax: 215-689-1418
Mailing address:
  • Phone: 215-925-2400
  • Fax: 215-925-9162

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