City of Philadelphia
Organization Active NPI Clinical Medical Laboratory · Phila, PA
NPI 1689688798 · NPPES record last updated Jun 11, 2019
Key facts
- NPI
- 1689688798
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- License
- 39D0657854 (PA)
- Legal business name
- CITY OF PHILADELPHIA
- Practice address
- 500 S Broad St FL 3
Phila, PA 19146 - Phone
- (215) 685-6812
- NPI assigned
- Jul 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Christine Gaddy
- Title
- Billing Manager
- Phone
- (215) 685-6843
Owned or controlled facilities with NPI records 8
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 22
Practitioners 175
-
Anne Carlyle Agre, LCSW
-
Fatema Ahmed, M.D.
-
Mini Alexander, FNP
-
Valerie Bonica, DO
-
Leslie Ann Cheeseman, M.D.
-
Esther Debra Chernak, M.D.
-
Patricia A. Daniels, D.P.M.
-
Binta Diallo, CRNP
-
Shashi Raj Divaker, M.D.
-
Karen Melissa Duckworth, M.D.
-
Rita Ngozi Eburuoh, M.D.
-
Binju Elias, PA-C
-
Deepthi Reddy Foxhall, M.D.
-
Jane Barron Fritz, M.D.
-
Bettyjane Gilbert, M.D.
-
Janel Elizabeth Hackney, M.D.
-
Leila Sheridan Hardware, D.O.
-
Laura A. Hribar, M.D.
-
Andrea Arnita Jackson, CRNP
-
Regina Janda, CRNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Department of Public Health - Philadelphia District HC #2 |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Feb 5, 2015 |
| Department of Public Health - Strawberry Mansion Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1985 |
| Department of Public Health - Philadelphia District Health Center #10 |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 2, 1976 |
| Department of Public Health - Philadelphia District HC #9 |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 1966 |
| Department of Public Health - Philadelphia District HC #6 |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 2, 1984 |
| Department of Public Health-Philadelphia District Health Center #4 |
Federally qualified health center | Operational/Managerial Control | Feb 24, 2011 |
| Department of Public Health-Philadelphia District HC #5 |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 2, 1980 |
| Department of Public Health - Philadelphia District Health Center #3 |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 15, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180530001164 | PA | Part B Supplier - Independent Clinical Laboratory | 6305758723 | Practice locations: Philadelphia, PA |
National Provider Directory
- Tax ID family
- Health Center 2
Locations (25 of 30)
23 W City Ave
Bala Cynwyd, PA 19004
Phone (610) 617-8500
603 E Sedgwick St
Phila, PA 19119
Phone (215) 248-3433
6376 City Ave
Phila, PA 19151
Phone (215) 877-2744
145 W Tioga St
Phila, PA 19140
Phone (215) 634-1800
87 E Haines St
Phila, PA 19144
Phone (215) 844-0954
1719 Morris St
Phila, PA 19145
Phone (215) 334-2312
6161 N 5th St
Phila, PA 19120
Phone (215) 424-1300
4801 N Mascher St
Phila, PA 19120
Phone (215) 455-3531
5415 Rising Sun Ave
Phila, PA 19120
Phone (215) 407-8364
167 W Allegheny Ave
Phila, PA 19140
Phone (215) 423-3070
3301 S 20th St
Phila, PA 19145
Phone (215) 462-2822
2110 Market St
Philadelphia, PA 19103
Phone (215) 686-9958
2426 N 2nd St
Philadelphia, PA 19133
Phone (215) 685-9846
8205 Roosevelt Blvd
Philadelphia, PA 19152
Phone (215) 685-8891
5627 Ridge Ave
Philadelphia, PA 19128
Phone (215) 483-7522
8724 Crispin Dr
Philadelphia, PA 19136
Phone (215) 332-0922
4700 Springfield Ave
Philadelphia, PA 19143
Phone (215) 727-0100
2230 Cottman Ave
#10
Philadelphia, PA 19149
Phone (215) 685-0602
1700 S Broad St
Apt 201
Philadelphia, PA 19145
Phone (215) 685-1800
711 S Broad St
Philadelphia, PA 19147
Phone (215) 685-6899
3205 Defense Ter
Philadelphia, PA 19129
Phone (215) 843-9720
3420 Haverford Ave
Philadelphia, PA 19104
Phone (215) 685-7698
7818 Frankford Ave
Philadelphia, PA 19136
Phone (215) 685-8896
3270 Comly Rd
Philadelphia, PA 19154
Phone (215) 685-9374
3031 Grays Fry Ave
City of Philadelphia Fire Dept
Philadelphia, PA 19146
Phone (215) 685-1790
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 39D0657854 | PA | Yes |
Addresses
Primary practice location
500 S Broad St FL 3
Phila, PA 19146
Mailing address
1101 Market St FL 10
Philadelphia, PA 19107-2911
Phone (215) 685-5306
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 398264 | Other | PA | HIGHMARK BLUE SHIELD |
| 0088763201 | Medicaid | PA |
Other names
- PHILA HEALTH DEPT LABORATORY
- CITY OF PHILADELPHIA
Other providers in Phila, PA
- Christa Habboushe, MD, LLC
- Debra Christian-Grandy
- Deborah Heeran Chun
- Augustine Ciardullo
- City of Phila
- Alfonso Clark
- Jerry Lee Clark
- Clhear Solutions, LLC
- Clinical Neurodevelopment Seminars
- Carter J Cloyd
All providers in Phila, PA · Clinical Medical Laboratory in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.