MEDICARE: SPECTRUM HEALTH SERVICES INC

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	091173	OTHER		HIGHMARK BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881629012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	5201 HAVERFORD AVE
Second Line	:	SPECTRUM HEALTH SERVICES, INC
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-1401
Country	:	US
Telephone Number	:	215-471-2761
Fax Number	:	215-472-6093

Provider Business Practice Location Address
First Line	:	1415 NORTH BROAD STREET
Second Line	:	BROAD STREET HEALTH CENTER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122
Country	:	US
Telephone Number	:	215-235-7944
Fax Number	:	215-235-0813

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MS. PHYLLIS B CATER
Credential	:
Telephone Number	:	215-471-2761

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/18/2015

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Directions to “SPECTRUM HEALTH SERVICES INC ” Practice Location

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