Healthcare Provider Details

I. General information

NPI: 1831209113
Provider Name (Legal Business Name): SAYRE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 WALNUT STREET REAR
PHILADELPHIA PA
19139
US

IV. Provider business mailing address

5800 WALNUT STREET REAR
PHILADELPHIA PA
19139-3836
US

V. Phone/Fax

Practice location:
  • Phone: 215-474-4444
  • Fax: 215-474-6021
Mailing address:
  • Phone: 215-474-4411
  • Fax: 215-474-6021

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: KENT BREAM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 215-474-4411