Healthcare Provider Details

I. General information

NPI: 1942317094
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

1700 S BROAD ST APT 201
PHILADELPHIA PA
19145-2340
US

IV. Provider business mailing address

500 S BROAD ST FL 2 INFORMATION & REIMBURSEMENT
PHILADELPHIA PA
19146-1613
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-1803
  • Fax: 215-685-1815
Mailing address:
  • Phone: 215-685-6863
  • 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