Provider Demographics
NPI:1750395653
Name:PUBLIC HEALTH MANAGEMENT CORP
Entity type:Organization
Organization Name:PUBLIC HEALTH MANAGEMENT CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-985-2514
Mailing Address - Street 1:260 S BROAD ST FL 18
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-5000
Mailing Address - Country:US
Mailing Address - Phone:215-985-2514
Mailing Address - Fax:267-765-2325
Practice Address - Street 1:500 ADAMS AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2102
Practice Address - Country:US
Practice Address - Phone:215-279-6666
Practice Address - Fax:215-279-9674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2012-04-11
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
PAG001140710OtherAMERICHOICE OF PA
PA2287757001OtherINDEPENDENCE BLUE CROSS
PA30010912OtherKEYSTONE MERCY
PA33926OtherHEALTH PARTNERS OF PA
PA001599865OtherPA HIGHMARK BLUE SHIELD
PA85942OtherAETNA
PA2287757001OtherINDEPENDENCE BLUE CROSS
391954Medicare Oscar/Certification