Healthcare Provider Details

I. General information

NPI: 1699882597
Provider Name (Legal Business Name): CITY OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 COTTMAN AVE
PHILADELPHIA PA
19149-1230
US

IV. Provider business mailing address

1101 MARKET ST FL 10 REVENUE MANAGEMENT
PHILADELPHIA PA
19107-2911
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-0603
  • Fax: 215-685-6848
Mailing address:
  • Phone: 215-685-5306
  • Fax: 215-685-6848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTINE GADDY
Title or Position: BILLING MANAGER
Credential:
Phone: 215-685-6843