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General NPI Number Information
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NPI Number | 1851454136
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Entity Type | Organization
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Legal Business Name | GREATER PHILADELPHIA HEALTH ACTION INC.
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 4510 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-3602
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Country | US
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Telephone | 215-535-1990
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Fax | 215-535-1935
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Provider Business Mailing Address
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Address Line | 1401 S 31ST ST 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19146-3506
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Country | US
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Telephone | 215-925-2400
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Fax | 215-925-9162
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT SPEC.
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Name | D TINA SMITH
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Credential |
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Telephone | 215-925-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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