MEDICARE: GREATER PHILADELPHIA HEALTH ACTION INCORPORATED

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1255943809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER PHILADELPHIA HEALTH ACTION INCORPORATED

Provider Business Mailing Address
First Line	:	1401 S 31ST ST FL 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-3506
Country	:	US
Telephone Number	:	215-925-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3116 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-3827
Country	:	US
Telephone Number	:	215-925-2400
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	CELESTE JOHNS
Credential	:
Telephone Number	:	215-925-2400

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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