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1216 E Hunting Park Ave Philadelphia PA 19124 | |
| (215) 533-1333 | |
| (215) 744-4324 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1216 E Hunting Park Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Kenneth Wiseman (PRESIDENT) |
| Authorized Official Contact | 2155331333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1216 E Hunting Park Ave Philadelphia PA 19124 Ph: (215) 533-1333 | 1216 E Hunting Park Ave Philadelphia PA 19124 Ph: (215) 533-1333 |
| NPI Number | 1982659611 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 08/13/2014 |
| Medicare PECOS PAC ID | 2062450943 |
|---|---|
| Medicare Enrollment ID | O20050421000036 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982659611 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS4457L (Pennsylvania) | Primary |
| Provider Name | Kenneth Wiseman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427083849 PECOS PAC ID: 8123104106 Enrollment ID: I20080401000285 |
| Provider Name | Steven P Schmidt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396770517 PECOS PAC ID: 1759469851 Enrollment ID: I20080415000242 |
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