Basic Information
| Provider Information | |||||||||
| NPI: | 1144502634 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PUBLIC HEALTH MANAGEMENT CORP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PHILADELPHIA HEALTH MANAGEMENT CORPORATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 S BROAD ST FL 18 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191025000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159852514 | ||||||||
| FaxNumber: | 2677652325 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 W SOMERSET ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191333534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157638870 | ||||||||
| FaxNumber: | 2152919153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2011 | ||||||||
| LastUpdateDate: | 04/11/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KILLIAN | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR - OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2159852514 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.