MEDICARE: SAYRE HEALTH CENTER

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	:	1831209113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAYRE HEALTH CENTER

Provider Business Mailing Address
First Line	:	5800 WALNUT STREET REAR
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3836
Country	:	US
Telephone Number	:	215-474-4411
Fax Number	:	215-474-6021

Provider Business Practice Location Address
First Line	:	5800 WALNUT STREET REAR
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139
Country	:	US
Telephone Number	:	215-474-4444
Fax Number	:	215-474-6021

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	KENT BREAM
Credential	:	MD
Telephone Number	:	215-474-4411

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/20/2012

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Directions to “SAYRE HEALTH CENTER ” Practice Location

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