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General NPI Number Information
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NPI Number | 1396636023
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Entity Type | Organization
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Legal Business Name | IMPACT COMMUNITY MEDICINE PA
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 2929 ARCH ST STE 1700
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City | PHILADELPHIA
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State | PA
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Zip | 19104-7327
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Country | US
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Telephone | 610-628-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 30 S 15TH ST STE 1550
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4806
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Country | US
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Telephone | 610-628-2004
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Fax |
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Authorized Official
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Title or Position | VP OF CLINICAL OPERATIONS
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Name | JENNIFER TUNNING
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Credential | LCSW
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Telephone | 610-628-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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