Provider Demographics
NPI:1124555909
Name:PUBLIC HEALTH MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:PUBLIC HEALTH MANAGEMENT CORPORATION
Other - Org Name:PHMC AT INTERIM HOUSE WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN./CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-985-2595
Mailing Address - Street 1:1500 MARKET ST
Mailing Address - Street 2:LM 500 WEST TOWER ATTN: D. PRITCHARD/SHS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4108 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1020
Practice Address - Country:US
Practice Address - Phone:215-871-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)