Organization
SOUTHBRIDGE MEDICAL ADVISORY COUNCIL INC
Active
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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