MEDICARE: DR. HOUSE CALL

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0391741001	OTHER	PA	KEYSTONE
2	000720954	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1275588543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. HOUSE CALL

Provider Business Mailing Address
First Line	:	1615 W OREGON AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19145-4500
Country	:	US
Telephone Number	:	215-334-2200
Fax Number	:	215-334-1125

Provider Business Practice Location Address
First Line	:	1615 W OREGON AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19145-4500
Country	:	US
Telephone Number	:	215-334-2200
Fax Number	:	215-334-1125

Authorized Official
Title or Position	:	CEO
Name	:	MRS. PATRICIA A PERNA
Credential	:
Telephone Number	:	215-334-2200

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/22/2008

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Directions to “DR. HOUSE CALL ” Practice Location

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