Gpha South Philadelphia Health Ctr. | |
1408 S. Broad St. 2nd Floor Philadelphia PA 19146-4808 | |
(215) 755-0700 | |
(215) 755-6474 |
Full Name | Gpha South Philadelphia Health Ctr. |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1408 S. Broad St., Philadelphia, Pennsylvania |
Authorized Official Name and Position | D Tina Smith (PROVIDER ENROLLMENT SPEC.) |
Authorized Official Contact | 2159252400 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Gpha South Philadelphia Health Ctr. 1401 S. 31st Street 2nd Floor Philadelphia PA 19146-3506 Ph: (215) 925-2400 | Gpha South Philadelphia Health Ctr. 1408 S. Broad St. 2nd Floor Philadelphia PA 19146-4808 Ph: (215) 755-0700 |
NPI Number | 1023485265 |
---|---|
Provider Enumeration Date | 08/24/2015 |
Last Update Date | 03/15/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023485265 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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