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1139 E Luzerne St Philadelphia PA 19124-5234 | |
| (215) 537-5094 | |
| (215) 537-5096 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1139 E Luzerne St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Ronald Kumor (SENIOR VICE PRESIDENT) |
| Authorized Official Contact | 2156124858 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 825395 Philadelphia PA 19182-5395 Ph: (215) 807-8000 | 1139 E Luzerne St Philadelphia PA 19124-5234 Ph: (215) 537-5094 |
| NPI Number | 1508991589 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 10/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508991589 | NPI | - | NPPES |
| 11055 | Other | PA | HEALTH PARTNERS |
| 1007526250039 | Medicaid | PA | |
| 381501 | Other | PA | HIGHMARK BLUE SHIELD |
| 1007526250041 | Medicaid | PA | |
| 1007526250051 | Medicaid | PA | |
| 2010 | Other | PA | AETNA |
| 381501 | Other | PA | PERSONAL CHOICE |
| 0422923001 | Other | PA | KEYSTONE, IBC |
| 1022049 | Other | PA | KEYSTONE MERCY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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