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8125 Stenton Ave Philadelphia PA 19150-3530 | |
| (215) 248-7560 | |
| (215) 248-7564 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 8125 Stenton Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Susan Denise Stukes (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2158441020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8125 Stenton Ave Philadelphia PA 19150-3530 Ph: (215) 248-7560 | 8125 Stenton Ave Philadelphia PA 19150-3530 Ph: (215) 248-7560 |
| NPI Number | 1528392008 |
|---|---|
| Provider Enumeration Date | 09/30/2009 |
| Last Update Date | 12/20/2023 |
| Medicare PECOS PAC ID | 3476591686 |
|---|---|
| Medicare Enrollment ID | O20111107000566 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528392008 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 032220 (Pennsylvania) | Primary |
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