| Philadelphia Fight | |
|
1233 Locust St Fl 4 Philadelphia PA 19107-5459 | |
| (215) 790-1788 | |
| (215) 732-5490 |
| Full Name | Philadelphia Fight |
|---|---|
| Speciality | Clinic/Center |
| Location | 1233 Locust St Fl 4, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Jose J Virella (CFO) |
| Authorized Official Contact | 9178423011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Philadelphia Fight 1233 Locust St Fl 3 Philadelphia PA 19107-5400 Ph: (215) 985-4448 | Philadelphia Fight 1233 Locust St Fl 4 Philadelphia PA 19107-5459 Ph: (215) 790-1788 |
| NPI Number | 1487082608 |
|---|---|
| Provider Enumeration Date | 10/25/2013 |
| Last Update Date | 11/03/2022 |
| Medicare PECOS PAC ID | 9032010319 |
|---|---|
| Medicare Enrollment ID | O20140529000237 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487082608 | NPI | - | NPPES |
| 100747222 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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