Basic Information
| Provider Information | |||||||||
| NPI: | 1437772795 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PUBLIC HEALTH MANAGMENT CORPORATION (PHMC) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 MARKET ST LOWR MEZZ | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191022100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159852500 | ||||||||
| FaxNumber: | 2159852550 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 HENRY AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191291141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156435400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2020 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | WUSSOW | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
| AuthorizedOfficialMiddleName: | MILTON | ||||||||
| AuthorizedOfficialTitleorPosition: | DIR OF FINANCE & REGULATORY AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 2159852575 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.