| |
1489 Baltimore Pike, Building 300, Suite 300 The Mills Of Victoria Springfield PA 19064-6024 | |
(484) 472-7430 | |
(484) 472-7718 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1489 Baltimore Pike, Building 300, Suite 300, Springfield, Pennsylvania |
Authorized Official Name and Position | D. Tina Smith (PROVIDER ENROLLMENT SPEC.) |
Authorized Official Contact | 2159252400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1401 S 31st St Fl 2 Philadelphia PA 19146-3506 Ph: (215) 925-2400 | 1489 Baltimore Pike, Building 300, Suite 300 The Mills Of Victoria Springfield PA 19064-6024 Ph: (484) 472-7430 |
NPI Number | 1467976001 |
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Provider Enumeration Date | 07/26/2017 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 9537064977 |
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Medicare Enrollment ID | O20170921003302 |
Identifier | Type | State | Issuer |
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1467976001 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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