1073037826 NPI number — GREATER PHILADELPHIA HEALTH ACTION INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073037826 NPI number — GREATER PHILADELPHIA HEALTH ACTION INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER PHILADELPHIA HEALTH ACTION INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073037826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 S 31ST ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19146-3506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-925-2400
Provider Business Mailing Address Fax Number:
215-925-9162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5630 VINE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19139-4703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-220-9006
Provider Business Practice Location Address Fax Number:
215-689-1418
Provider Enumeration Date:
08/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
D.
Authorized Official Middle Name:
TINA
Authorized Official Title or Position:
PROVIDER ENROLLMENT SPEC.
Authorized Official Telephone Number:
215-925-2400

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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