MEDICARE: PAN AMERICAN MENTAL HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	195600	PA

General Provider Information

NPI Number	:	1093867772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAN AMERICAN MENTAL HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	4519 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2309
Country	:	US
Telephone Number	:	215-457-1620
Fax Number	:	215-457-0350

Provider Business Practice Location Address
First Line	:	4519 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2309
Country	:	US
Telephone Number	:	215-457-1620
Fax Number	:	215-457-0350

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. FREDERICK RAMIREZ
Credential	:	MSW
Telephone Number	:	215-457-1620

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	04/07/2026

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