| Gpha South Philadelphia Health Ctr. | |
|
1408 S. Broad St. 2nd Floor Philadelphia PA 19146-4808 | |
| (215) 755-0700 | |
| (215) 755-6474 |
| Full Name | Gpha South Philadelphia Health Ctr. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1408 S. Broad St., Philadelphia, Pennsylvania |
| Authorized Official Name and Position | D Tina Smith (PROVIDER ENROLLMENT SPEC.) |
| Authorized Official Contact | 2159252400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gpha South Philadelphia Health Ctr. 1401 S. 31st Street 2nd Floor Philadelphia PA 19146-3506 Ph: (215) 925-2400 | Gpha South Philadelphia Health Ctr. 1408 S. Broad St. 2nd Floor Philadelphia PA 19146-4808 Ph: (215) 755-0700 |
| NPI Number | 1023485265 |
|---|---|
| Provider Enumeration Date | 08/24/2015 |
| Last Update Date | 03/15/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023485265 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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