Wedge Medical Center

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

WEDGE MEDICAL CENTER

Practice address

3600 Germantown Ave
Philadelphia, PA 19140-4226

Phone

(215) 223-3600

Fax

(215) 223-2100

NPI assigned

Jul 19, 2019

Last updated

Jan 12, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

WEDGE MEDICAL CENTER, PCAs reported in NPPES

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

Authorized official

Name

Takisa Gallman

Title

VP Administrative Services

Phone

(215) 276-3922

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wedge Medical Center, PC Other name

Part of

Wedge Medical Center PC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Wedge Medical Center, PC

  • Addiction (Substance Use Disorder) Counselor
  • Philadelphia, PA
  • NPI 1215176342
  NPPES parent name

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610409600000",
    "number": "1336792316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6711 OLD YORK RD OFC",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191262841",
            "telephone_number": "215-276-3922",
            "fax_number": "215-276-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 GERMANTOWN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404226",
            "telephone_number": "215-223-3600",
            "fax_number": "215-223-2100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3604 Germantown Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191404226",
            "country_code": "US",
            "telephone_number": "215-223-3600",
            "fax_number": "215-223-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WEDGE MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEDGE MEDICAL CENTER, PC",
        "enumeration_date": "2019-07-19",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A",
        "authorized_official_last_name": "GALLMAN",
        "authorized_official_first_name": "TAKISA",
        "authorized_official_title_or_position": "VP ADMINISTRATIVE SERVICES",
        "authorized_official_telephone_number": "215-276-3922"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001680493",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wedge Medical Center, PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Community/Behavioral Health Agency in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Community/Behavioral Health Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; 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.