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General NPI Number Information
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NPI Number | 1881018018
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Entity Type | Organization
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Legal Business Name | CITY OF PHILADELPHIA
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Dates
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Enumeration Date | 02/07/2014
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 1930 S BROAD ST UNIT 14, 5TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19145-2328
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Country | US
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Telephone | 215-685-1803
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Fax | 215-685-6700
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Provider Business Mailing Address
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Address Line | 500 S BROAD ST 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1613
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Country | US
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Telephone | 215-685-6843
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Fax | 215-685-6700
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Authorized Official
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Title or Position | REGIONAL MANAGER/FINANCIAL SERVICES
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Name | MRS. JANET LYNN STEVENSON
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Credential | BS, MBA
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Telephone | 215-685-6792
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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 |
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