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1200 Callowhill St Suite 101 Philadelphia PA 19123-3658 | |
| (215) 825-8220 | |
| (215) 825-8254 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1200 Callowhill St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Frank Killian (DIRECTOR OF FINANCE AND REGULATORY) |
| Authorized Official Contact | 2159852514 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1500 Market St Lm-500 West Tower Philadelphia PA 19102-2100 Ph: (215) 985-2500 | 1200 Callowhill St Suite 101 Philadelphia PA 19123-3658 Ph: (215) 825-8220 |
| NPI Number | 1467776989 |
|---|---|
| Provider Enumeration Date | 03/26/2010 |
| Last Update Date | 12/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467776989 | NPI | - | NPPES |
| 1000016640054 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Pennsylvania) | Primary |
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