Organization
MIRIAM MEDICAL CLINICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA KAY JOHNSON M.B.A. (CFO)
(215) 644-8745
Entity
Organization
Contact information
Practice address
2006 TASKER ST, PHILADELPHIA, PA 19145-1432
(215) 644-8745
(215) 644-8713
Mailing address
2006 TASKER ST, PHILADELPHIA, PA 19145-1432
(215) 644-8745
(215) 644-8713
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
PA
208D00000X
General Practice Physician
—
PA
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
08/11/2014
Last updated
03/19/2024
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