Organization
CITY OF PHILADELPHIA
Active
Other names
CITY OF PHILADELPHIA, PHILA HEALTH DEPT LABORATORY
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE GADDY (BILLING MANAGER)
(215) 685-6843
Entity
Organization
Contact information
Practice address
500 S BROAD ST FL 3, PHILA, PA 19146
(215) 685-6812
Mailing address
1101 MARKET ST FL 10, PHILADELPHIA, PA 19107-2911
(215) 685-5306
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
39D0657854
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0088763201
—
PA
01
—
398264
HIGHMARK BLUE SHIELD
PA
Enumeration date
07/27/2006
Last updated
06/11/2019
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