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1900 N 20th St Health Care Center 5 Philadelphia PA 19121-2217 | |
| (215) 685-2973 | |
| (215) 685-6848 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1900 N 20th St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Christine Gaddy (BILLING MANAGER) |
| Authorized Official Contact | 2156856843 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1101 Market St Fl 10 Revenue Management Philadelphia PA 19107-2911 Ph: (215) 685-5306 | 1900 N 20th St Health Care Center 5 Philadelphia PA 19121-2217 Ph: (215) 685-2973 |
| NPI Number | 1518074566 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 12/03/2019 |
| Medicare PECOS PAC ID | 6305758723 |
|---|---|
| Medicare Enrollment ID | O20110118000983 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518074566 | NPI | - | NPPES |
| 1000076950011 | Medicaid | PA | |
| G0001585 | Medicaid | PA | |
| 66692 | Other | PA | HIGHMARK BLUE SHIELD |
| 100085 | Medicaid | PA | |
| 03074 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Pennsylvania) | Primary |
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