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5800 Ridge Ave Philadelphia PA 19128-1737 | |
| (215) 487-4245 | |
| (215) 487-4274 |
| Full Name | |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 5800 Ridge Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | John J Donnelly (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2154874245 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5800 Ridge Ave Philadelphia PA 19128-1737 Ph: (215) 487-4245 | 5800 Ridge Ave Philadelphia PA 19128-1737 Ph: (215) 487-4245 |
| NPI Number | 1821020421 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 08/24/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821020421 | NPI | - | NPPES |
| 09801 | Other | HEALTH PARTNERS | |
| 1430 | Other | AETNA US HEALTHCARE | |
| 1019096660001 | Medicaid | PA | |
| 390304B000000 | Other | SECTION 1011 | |
| 1757000 | Other | KEYSTONE HEALTH PLAN EAST | |
| 318955 | Other | PACIFICARE | |
| 9801 | Other | HEALTH PARTNERS | |
| 0062197 | Medicaid | NJ | |
| 1500883 | Medicaid | KY | |
| 30042522 | Other | KEYSTONE MERCY HEALTH PLA | |
| 11056A | Medicaid | SC | |
| 0005633000 | Other | PA | INDEPENDENCE BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 282N00000X | General Acute Care Hospital | 910401 (Pennsylvania) | Primary |
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