MEDICARE: WMC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1659924678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WMC

Provider Business Mailing Address
First Line	:	6711 OLD YORK RD OFC
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2841
Country	:	US
Telephone Number	:	215-276-3922
Fax Number	:	215-276-1249

Provider Business Practice Location Address
First Line	:	4913 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2215
Country	:	US
Telephone Number	:	215-276-3922
Fax Number	:	215-276-8199

Authorized Official
Title or Position	:	VP ADMINISTRATIVE SERVICES
Name	:	TAKISA S GALLMAN
Credential	:
Telephone Number	:	215-276-3922

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	07/18/2019

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Directions to “WMC ” Practice Location

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