Provider Demographics
NPI:1689688798
Name:CITY OF PHILADELPHIA
Entity Type:Organization
Organization Name:CITY OF PHILADELPHIA
Other - Org Name:PHILA HEALTH DEPT LABORATORY
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:
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:
Practice Address - Street 1:500 S BROAD ST FL 3
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19146
Practice Address - Country:US
Practice Address - Phone:215-685-6812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39D0657854291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA398264OtherHIGHMARK BLUE SHIELD
PA0088763201Medicaid
PA398264Medicare ID - Type UnspecifiedCLINICAL LAB