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General NPI Number Information
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NPI Number | 1194822155
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Entity Type | Organization
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Legal Business Name | PUBLIC HEALTH MANAGEMENT CORP
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 1035 W BERKS ST
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City | PHILADELPHIA
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State | PA
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Zip | 19122-1909
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Country | US
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Telephone | 215-765-6690
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Fax | 215-765-6694
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Provider Business Mailing Address
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Address Line | 260 S BROAD ST FL 18
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City | PHILADELPHIA
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State | PA
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Zip | 19102-5000
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Country | US
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Telephone | 215-765-6690
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Fax | 215-765-6694
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Authorized Official
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Title or Position | DIRECTOR - OPERATIONS
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Name | MR. FRANK KILLIAN
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Credential |
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Telephone | 215-985-2514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | PA
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