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Organization

GREATER PHILADELPHIA HEALTH ACTION, INC

Active
Other names
GPHA 4th Street Medical Suite
Organization subpart
No

Provider details

NPI number
Authorized official
MS. D TINA SMITH (PROVIDER ENROLLMENT SPEC.)
(215) 925-2400
Entity
Organization

Contact information

Practice address
1401 S. 4TH STREET, 4TH FLOOR, PHILADELPHIA, PA 19147-5948
(215) 339-1079
(215) 952-6966
Mailing address
1401 S. 31ST STREET, 2ND FLOOR, PHILADELPHIA, PA 19146-3506
(215) 925-2400
(215) 925-9162

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
103T00000X
Psychologist
104100000X
Social Worker
176B00000X
Midwife
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
207V00000X
Obstetrics & Gynecology Physician
208000000X
Pediatrics Physician
2080C0008X
Child Abuse Pediatrics Physician
2084P0800X
Psychiatry Physician
213E00000X
Podiatrist
261Q00000X
Clinic/Center
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1001374480022
PA
Enumeration date
05/22/2006
Last updated
03/15/2017
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