Organization
SOUTHBRIDGE MEDICAL ADVISORY COUNCIL INC
Active
Other names
Henrietta Johnson Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROSA V RIVERA (CHIEF EXECUTIVE OFFICER)
(302) 655-6187
Entity
Organization
Contact information
Practice address
601 NEW CASTLE AVE, WILMINGTON, DE 19801
(302) 655-6187
(302) 655-6606
Mailing address
601 NEW CASTLE AVE, WILMINGTON, DE 19801
(302) 655-6187
(302) 655-6606
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
207Q00000X
Family Medicine Physician
—
—
207VG0400X
Gynecology Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000332866
—
DE
01
—
458117
TRAIL BLAZER
—
Enumeration date
08/22/2006
Last updated
01/16/2013
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