MEDICARE: PUBLIC HEALTH MANAGEMENT CORPORATION

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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417382888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIC HEALTH MANAGEMENT CORPORATION

Provider Business Mailing Address
First Line	:	1500 MARKET ST
Second Line	:	LM 500 WEST TOWER
City	:	PHILA
State	:	PA
Zip	:	19102-2100
Country	:	US
Telephone Number	:	215-985-2500
Fax Number	:	267-765-2325

Provider Business Practice Location Address
First Line	:	1900 N 9TH ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19122-2024
Country	:	US
Telephone Number	:	215-765-6690
Fax Number	:	215-765-2506

Authorized Official
Title or Position	:	DIRECTOR-OPERATIONS
Name	:	MR. FRANK KILLIAN
Credential	:
Telephone Number	:	215-985-2514

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	12/11/2020

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Directions to “PUBLIC HEALTH MANAGEMENT CORPORATION ” Practice Location

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