Provider Demographics
NPI:1063464055
Name:WMC
Entity Type:Organization
Organization Name:WMC
Other - Org Name:THE WEDGE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP ADMINISTRATIVE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TAKISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-276-3922
Mailing Address - Street 1:6711 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-2841
Mailing Address - Country:US
Mailing Address - Phone:215-276-3922
Mailing Address - Fax:215-276-5042
Practice Address - Street 1:6701 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-2837
Practice Address - Country:US
Practice Address - Phone:215-276-3922
Practice Address - Fax:215-924-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty