Organization
CITY OF PHILADELPHIA
Active
Other names
Health Center 10
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE GADDY (BILLING MANAGER)
(215) 685-6843
Entity
Organization
Contact information
Practice address
2230 COTTMAN AVE, PHILADELPHIA, PA 19149-1230
(215) 685-0603
(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
—
03235
—
PA
05
—
1000076950014
—
PA
05
—
100087
—
PA
01
—
66692
HIGHMARK BLUE SHIELD
PA
05
—
G000141
—
PA
Enumeration date
08/24/2006
Last updated
11/25/2019
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