MEDICARE: PHIL. COUNTY-DEPT. OF HEALTH TSM

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1275753808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHIL. COUNTY-DEPT. OF HEALTH TSM

Provider Business Mailing Address
First Line	:	1101 MARKET ST
Second Line	:	7TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-2934
Country	:	US
Telephone Number	:	215-685-5460
Fax Number	:	215-685-5467

Provider Business Practice Location Address
First Line	:	701 MARKET ST
Second Line	:	5TH FLOOR, SUITE 5200
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-1538
Country	:	US
Telephone Number	:	215-685-5906
Fax Number	:	215-685-5959

Authorized Official
Title or Position	:	DEPUTY DIRECTOR DBH MRS
Name	:	MR. MICHAEL J COVONE
Credential	:
Telephone Number	:	215-685-5460

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/22/2020

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