| Covenant House Inc | |
|
251 East Bringhurst Street Philadelphia PA 19144 | |
| (215) 844-1020 | |
| (215) 844-2702 |
| Full Name | Covenant House Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 251 East Bringhurst Street, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Susan Denise Stukes (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2158441020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Covenant House Inc 251 East Bringhurst Street Philadelphia PA 19144 Ph: (215) 844-1020 | Covenant House Inc 251 East Bringhurst Street Philadelphia PA 19144 Ph: (215) 844-1020 |
| NPI Number | 1659462679 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 09/20/2023 |
| Medicare PECOS PAC ID | 3476591686 |
|---|---|
| Medicare Enrollment ID | O20050419000796 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659462679 | NPI | - | NPPES |
| 1026476 | Other | KEYSTONE MERCY HEALTH PLA | |
| 1007564460003 | Medicaid | PA | |
| 0073796701 | Other | AMERI CHOICE | |
| 00652 | Other | HEALTH PARTNERS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 032220 (Pennsylvania) | Primary |
| Provider Name | Patrick T Waters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356302715 PECOS PAC ID: 6507778826 Enrollment ID: I20031104000436 |
| Provider Name | Joan Addley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275532160 PECOS PAC ID: 1759315898 Enrollment ID: I20050919000925 |
| Provider Name | Mark E Kobb |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1609817923 PECOS PAC ID: 4789609892 Enrollment ID: I20051007000598 |
| Provider Name | Joel I Wagman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609860519 PECOS PAC ID: 0345209698 Enrollment ID: I20090618000055 |
| Provider Name | Regina E Stanton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548337819 PECOS PAC ID: 0840332490 Enrollment ID: I20100423000682 |
| Provider Name | Maasi J Smith |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1427094259 PECOS PAC ID: 2567367568 Enrollment ID: I20110404000268 |
| Provider Name | Jeannie M Peake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801065842 PECOS PAC ID: 2860615036 Enrollment ID: I20140516000846 |
| Provider Name | Juanita S Burton |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124067699 PECOS PAC ID: 4587881792 Enrollment ID: I20140812002112 |
| Provider Name | Carly E Hampton |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1104168921 PECOS PAC ID: 9436454378 Enrollment ID: I20160301002114 |
| Provider Name | Susan D Stukes |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1306146923 PECOS PAC ID: 4486995271 Enrollment ID: I20190404000058 |
| Provider Name | Kelley J White |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1902952906 PECOS PAC ID: 4082738463 Enrollment ID: I20190520002090 |
| Provider Name | Tryphena S Hsi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942784731 PECOS PAC ID: 9638412372 Enrollment ID: I20190520002477 |
| Provider Name | Shannon Voelker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033864657 PECOS PAC ID: 8729465349 Enrollment ID: I20220519001125 |
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