Organization
PHILADELPHIA FIGHT
Active
Organization
PHILADELPHIA FIGHT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE J VIRELLA (CFO)
(917) 842-3011
Entity
Organization
Contact information
Practice address
1233 LOCUST ST FL 4, PHILADELPHIA, PA 19107-5459
(215) 790-1788
(215) 732-5490
Mailing address
1233 LOCUST ST FL 3, PHILADELPHIA, PA 19107-5400
(215) 985-4448
(215) 732-1145
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100747222
—
PA
Enumeration date
10/25/2013
Last updated
11/03/2022
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