Provider Demographics
NPI:1689045437
Name:SPECTRUM HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SPECTRUM HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:CATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-471-2761
Mailing Address - Street 1:5201 HAVERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1401
Mailing Address - Country:US
Mailing Address - Phone:215-471-2761
Mailing Address - Fax:215-472-6093
Practice Address - Street 1:1325 S 33RD ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-3303
Practice Address - Country:US
Practice Address - Phone:215-471-2761
Practice Address - Fax:215-472-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100728826Medicaid
PA091193OtherHIGHMARK BLUE SHIELD
PA391071Medicare Oscar/Certification