1417064353 NPI number — CITY OF PHILADELPHIA

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 1417064353 NPI number — CITY OF PHILADELPHIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF PHILADELPHIA
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:
1417064353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 MARKET ST FL 10
Provider Second Line Business Mailing Address:
REVENUE MANAGEMENT
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-2911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-685-5306
Provider Business Mailing Address Fax Number:
215-685-6848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2840 W DAUPHIN ST
Provider Second Line Business Practice Location Address:
STRAWBERRY MANSION HEALTH CTR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19132-4627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-685-2403
Provider Business Practice Location Address Fax Number:
215-685-6848
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GADDY
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
215-685-6843

Provider Taxonomy Codes

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

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

  • Identifier: 66692 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: G0001311 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00900 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000076950015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1008117 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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