Community Primary Care Center

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

SP011218 Issued in PA

Legal business name

COMMUNITY PRIMARY CARE CENTER

Practice address

702 W Girard Ave
Philadelphia, PA 19123-1313

Phone

(215) 301-1193

NPI assigned

Nov 9, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melissa J Tucker, CRNP

Title

Owner

Phone

(215) 301-1193

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478649600000",
    "number": "1023550977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 W GIRARD AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191231313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 W GIRARD AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191231313",
            "telephone_number": "215-301-1193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY PRIMARY CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-09",
        "last_updated": "2016-11-09",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-301-1193",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "PA",
            "license": "SP011218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Primary Care Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.