Provider Demographics
NPI:1821172107
Name:PHILADELPHIA DEPT. OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:PHILADELPHIA DEPT. OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
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 12
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2934
Mailing Address - Country:US
Mailing Address - Phone:215-685-6843
Mailing Address - Fax:
Practice Address - Street 1:1101 MARKET ST FL 12
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-685-6843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000076950008Medicaid
PA1000076950008Medicaid
PA391875Medicare ID - Type UnspecifiedUGS FQHC
PA391872Medicare ID - Type UnspecifiedUGS FQHC
PA391876Medicare ID - Type UnspecifiedUGS FQHC
PA391877Medicare ID - Type UnspecifiedUGS FQHC
PA398264Medicare ID - Type UnspecifiedHIGHMARK MEDICARE
PA66692Medicare ID - Type UnspecifiedHIGHMARK MEDICARE
PA391878Medicare ID - Type UnspecifiedUGS FQHC
PA391874Medicare ID - Type UnspecifiedUGS FQHC
PA391879Medicare ID - Type UnspecifiedUGS FQHC
GA00920000000Medicare ID - Type UnspecifiedRAILROAD RETIREMENT