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216 W Somerset St Philadelphia PA 19133-3534 | |
| (267) 765-2272 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 216 W Somerset St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Frank Killian (DIRECTOR FINANCE & REGULATORY AFFAI) |
| Authorized Official Contact | 2159852514 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1500 Market St Lm 500 West Tower Phila PA 19102-2100 Ph: (215) 985-2500 | 216 W Somerset St Philadelphia PA 19133-3534 Ph: (267) 765-2272 |
| NPI Number | 1598156804 |
|---|---|
| Provider Enumeration Date | 02/09/2015 |
| Last Update Date | 02/17/2021 |
| Medicare PECOS PAC ID | 1850307406 |
|---|---|
| Medicare Enrollment ID | O20160314001823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598156804 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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