Organization
GREATER PHILADELPHIA HEALTH ACTION INC.
Active
Other names
GPHA Southeast Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
D TINA SMITH (PROVIDER ENROLLMENT SPEC)
(215) 925-2400
Entity
Organization
Contact information
Practice address
800 WASHINGTON AVE, PHILADELPHIA, PA 19147-4717
(215) 339-5100
(215) 454-6814
Mailing address
1401 S 31ST ST, 2ND FLOOR, PHILADELPHIA, PA 19146-3506
(215) 925-2400
(215) 925-9162
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
213E00000X
Podiatrist
—
—
261Q00000X
Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001374480051
—
PA
Enumeration date
05/22/2006
Last updated
03/16/2017
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