| Mednet Healthcare Systems Inc. | |
|
9150 Marshall St Philadelphia PA 19114-2217 | |
| (215) 294-6790 | |
| (215) 253-5305 |
| Full Name | Mednet Healthcare Systems Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 9150 Marshall St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Henry I Balogun (CHAIRMAN/CEO) |
| Authorized Official Contact | 2154744410 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mednet Healthcare Systems Inc. 9150 Marshall St Philadelphia PA 19114-2217 Ph: (215) 294-6790 | Mednet Healthcare Systems Inc. 9150 Marshall St Philadelphia PA 19114-2217 Ph: (215) 294-6790 |
| NPI Number | 1568559714 |
|---|---|
| Provider Enumeration Date | 10/09/2006 |
| Last Update Date | 03/20/2015 |
| Medicare PECOS PAC ID | 5890606685 |
|---|---|
| Medicare Enrollment ID | O20050322000361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568559714 | NPI | - | NPPES |
| 0018467050006 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | 101200 (Pennsylvania) | Secondary |
| Provider Name | Nyok - Kheng Lim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952322356 PECOS PAC ID: 6204737950 Enrollment ID: I20040116000150 |
| Provider Name | Olutope Fakiyesi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407879109 PECOS PAC ID: 5294784484 Enrollment ID: I20050114000113 |
| Provider Name | Richard B Cornfield |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073602595 PECOS PAC ID: 6709832793 Enrollment ID: I20050323000316 |
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