Provider Demographics
NPI:1194822155
Name:PUBLIC HEALTH MANAGEMENT CORP
Entity Type:Organization
Organization Name:PUBLIC HEALTH MANAGEMENT CORP
Other - Org Name:PHILADELPHIA HEALTH MANAGEMENT CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR - OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-985-2514
Mailing Address - Street 1:260 S BROAD ST FL 18
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-5000
Mailing Address - Country:US
Mailing Address - Phone:215-765-6690
Mailing Address - Fax:215-765-6694
Practice Address - Street 1:1035 W BERKS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-1909
Practice Address - Country:US
Practice Address - Phone:215-765-6690
Practice Address - Fax:215-765-6694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000016640039Medicaid
PA040886Medicare PIN