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500 S Broad St Second Floor Philadelphia PA 19146-1613 | |
| (215) 685-6741 | |
| (215) 545-8362 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Public Health, State Or Local |
| Location | 500 S Broad St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Caroline Johnson (DIRECTOR, DIV. OF DISEASE CONTROL) |
| Authorized Official Contact | 2156856741 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
500 S Broad St Second Floor Philadelphia PA 19146-1613 Ph: (215) 685-6741 | 500 S Broad St Second Floor Philadelphia PA 19146-1613 Ph: (215) 685-6741 |
| NPI Number | 1578861605 |
|---|---|
| Provider Enumeration Date | 03/15/2011 |
| Last Update Date | 04/03/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578861605 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0905X | Clinic/center - Public Health, State Or Local | (* (Not Available)) | Primary |
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