Provider Demographics
NPI:1831209113
Name:SAYRE HEALTH CENTER
Entity type:Organization
Organization Name:SAYRE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BREAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-474-4411
Mailing Address - Street 1:5800 WALNUT STREET REAR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3836
Mailing Address - Country:US
Mailing Address - Phone:215-474-4411
Mailing Address - Fax:215-474-6021
Practice Address - Street 1:5800 WALNUT STREET REAR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139
Practice Address - Country:US
Practice Address - Phone:215-474-4444
Practice Address - Fax:215-474-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019704400001Medicaid
PA1019704400001Medicaid