Organization
CITY OF PHILADELPHIA
Active
Other names
Health Care Center 4
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE GADDY (BILLING MANAGER)
(215) 685-6843
Entity
Organization
Contact information
Practice address
4400 HAVERFORD AVE, PHILADELPHIA, PA 19104-1361
(215) 685-7628
(215) 685-6848
Mailing address
1101 MARKET ST FL 10, REVENUE MANAGEMENT, PHILADELPHIA, PA 19107-2911
(215) 685-5306
(215) 685-6848
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000076950010
—
PA
05
—
100084
—
PA
05
—
33104
—
PA
01
—
66692
HIGHMARK BLUE SHIELD
PA
05
—
G0004755
—
PA
Enumeration date
08/24/2006
Last updated
11/25/2019
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