Organization
PHILADELPHIA DEPT. OF PUBLIC HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE GADDY (BILLING MANAGER)
(215) 685-6843
Entity
Organization
Contact information
Practice address
1101 MARKET ST FL 12, PHILADELPHIA, PA 19107
(215) 685-6843
Mailing address
1101 MARKET ST FL 12, PHILADELPHIA, PA 19107-2934
(215) 685-6843
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000076950008
—
PA
Enumeration date
10/24/2006
Last updated
06/11/2019
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