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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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