Provider Demographics
NPI:1518074566
Name:CITY OF PHILADELPHIA
Entity Type:Organization
Organization Name:CITY OF PHILADELPHIA
Other - Org Name:HEALTH CARE CENTER 5
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-685-6843
Mailing Address - Street 1:1101 MARKET ST FL 10
Mailing Address - Street 2:REVENUE MANAGEMENT
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2911
Mailing Address - Country:US
Mailing Address - Phone:215-685-5306
Mailing Address - Fax:215-685-6848
Practice Address - Street 1:1900 N 20TH ST
Practice Address - Street 2:HEALTH CARE CENTER 5
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-2217
Practice Address - Country:US
Practice Address - Phone:215-685-2973
Practice Address - Fax:215-685-6848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2019-12-03
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
PA1000076950011Medicaid
PAG0001585Medicaid
PA66692OtherHIGHMARK BLUE SHIELD
PA100085Medicaid
PA03074Medicaid
PA03074Medicaid
PA85928Medicare ID - Type UnspecifiedAETNA
PA1000076950011Medicaid
PA0060187016Medicare ID - Type UnspecifiedINDEPENDENCE BLUE CROSS
PA100085Medicaid