| The Wedge Medical Center, P.c. | |
|
3609 N Broad St Philadelphia PA 19140-4107 | |
| (215) 223-1100 | |
| (215) 223-1200 |
| Full Name | The Wedge Medical Center, P.c. |
|---|---|
| Speciality | Counselor - Professional |
| Location | 3609 N Broad St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Takisa S Gallman (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Contact | 2152763922 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Wedge Medical Center, P.c. 3609 N Broad St Philadelphia PA 19140-4107 Ph: (215) 223-1100 | The Wedge Medical Center, P.c. 3609 N Broad St Philadelphia PA 19140-4107 Ph: (215) 223-1100 |
| NPI Number | 1053538447 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053538447 | NPI | - | NPPES |
| 1007281920005 | Medicaid | PA | |
| 1007281920009 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 807376 (Pennsylvania) | Primary |
| 101YP2500X | Counselor - Professional | 807376 (Pennsylvania) | Primary |
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