Healthcare Provider Details

I. General information

NPI: 1750395653
Provider Name (Legal Business Name): PUBLIC HEALTH MANAGEMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ADAMS AVENUE
PHILADELPHIA PA
19120-2102
US

IV. Provider business mailing address

260 S BROAD ST FL 18
PHILADELPHIA PA
19102-5000
US

V. Phone/Fax

Practice location:
  • Phone: 215-279-6666
  • Fax: 215-279-9674
Mailing address:
  • Phone: 215-985-2514
  • Fax: 267-765-2325

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: MR. FRANK KILLIAN
Title or Position: DIRECTOR-OPERATIONS
Credential:
Phone: 215-985-2514