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Organization

CITY OF PHILADELPHIA

Active
Other names
Health Care Center 5
Organization subpart
No

Provider details

NPI number
Authorized official
CHRISTINE GADDY (BILLING MANAGER)
(215) 685-6843
Entity
Organization

Contact information

Practice address
1900 N 20TH ST, HEALTH CARE CENTER 5, PHILADELPHIA, PA 19121-2217
(215) 685-2973
(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
03074
PA
05
1000076950011
PA
05
100085
PA
01
66692
HIGHMARK BLUE SHIELD
PA
05
G0001585
PA
Enumeration date
08/24/2006
Last updated
12/03/2019
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