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1618 South St Ground Floor Philadelphia PA 19146-1542 | |
| (215) 575-5085 | |
| (215) 278-2965 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1618 South St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Bruce Donald Hopper (PRINCIPAL) |
| Authorized Official Contact | 2155755085 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1618 South St Ground Floor Philadelphia PA 19146-1542 Ph: (215) 575-5085 | 1618 South St Ground Floor Philadelphia PA 19146-1542 Ph: (215) 575-5085 |
| NPI Number | 1609187665 |
|---|---|
| Provider Enumeration Date | 06/24/2010 |
| Last Update Date | 07/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609187665 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MD421377 (Pennsylvania) | Primary |
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