Provider Demographics
NPI:1942317094
Name:CITY OF PHILADELPHIA
Entity Type:Organization
Organization Name:CITY OF PHILADELPHIA
Other - Org Name:HEALTH CARE CENTER 2
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 1:500 S BROAD ST FL 2
Mailing Address - Street 2:INFORMATION & REIMBURSEMENT
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1613
Mailing Address - Country:US
Mailing Address - Phone:215-685-6863
Mailing Address - Fax:215-685-6848
Practice Address - Street 1:1700 S BROAD ST APT 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2340
Practice Address - Country:US
Practice Address - Phone:215-685-1803
Practice Address - Fax:215-685-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2019-11-25
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
PA1000076950098Medicaid
PAG0002730Medicaid
PA16792Medicaid
PA1002859Medicaid
PA666921Medicare ID - Type UnspecifiedHIGHMARK MEDICARE
PA1000076950008Medicaid
PA16792Medicaid
PA0834569001Medicare ID - Type UnspecifiedINDEPENDENCE BLUE CROSS
PA1002859Medicaid