The Wedge Medical Center, P.C.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

807376 Issued in PA

Legal business name

THE WEDGE MEDICAL CENTER, P.C.

Practice address

3609 N Broad St
Philadelphia, PA 19140-4107

Phone

(215) 223-1100

Fax

(215) 223-1200

NPI assigned

Apr 19, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Takisa S Gallman

Title

Administrative Director

Phone

(215) 276-3922

Specialties & licenses 2

Addresses

Other identifiers 2

Tax ID family

Wedge Medical Center PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• The Wedge Medical Center, P.C.

  • Community/Behavioral Health Agency
  • Philadelphia, PA
  • NPI 1396455945
  NPD tax ID
• The Wedge Medical Center, P.C.

  • Addiction (Substance Use Disorder) Counselor
  • Philadelphia, PA
  • NPI 1508806886
  NPD tax ID
• The Wedge Medical Center, P.C.

  • Professional Counselor
  • Philadelphia, PA
  • NPI 1730306291
  NPD tax ID
• Wedge Medical Center, PC

  • Addiction (Substance Use Disorder) Counselor
  • Philadelphia, PA
  • NPI 1215176342
  NPD tax ID

Locations

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1053538447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3609 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404107",
            "telephone_number": "215-223-1100",
            "fax_number": "215-223-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3609 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404107",
            "telephone_number": "215-223-1100",
            "fax_number": "215-223-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WEDGE MEDICAL CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "GALLMAN",
        "authorized_official_first_name": "TAKISA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "215-276-3922",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "PA",
            "license": "807376",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "807376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007281920005",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007281920009",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• The Walter D. Palmer Leadership Learning Partners Charter School
• The Wedge Medical Center, P.C.
• The Wedge Medical Center, P.C.
• The Wedge Medical Center, P.C.
• Linda Thea
• Simon Daniel Xavier Thebault, M.D.

• Professional Counselor in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.