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WEDGE MEDICAL CENTER PC NPI 1215176342


NPI Information

NPI: 1215176342
Provider Name: WEDGE MEDICAL CENTER, PC
Classification: Counselor - 101YA0400X
Entity Type: Organization

Specialization: Addiction (Substance Use Disorder)

CLIA Number: 39D2180569

Address:
4243 FRANKFORD AVENUE
PHILADELPHIA, PA
ZIP 19124
Phone: (215) 744-3600
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WEDGE MEDICAL CENTER, PC is an addiction (substance use disorder) counselor in Philadelphia, PA. WEDGE MEDICAL CENTER, PC NPI is 1215176342. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4243 FRANKFORD AVENUE
PHILADELPHIA, PA
ZIP 19124
Phone: (215) 744-3600
Fax: (215) 744-1400

The provider's authorized official is Takisa S. Gallman .
The authorized official title is Administrative Director and has the following contact phone number (215) 276-3922.

The CLIA number assigned to this NPI record is 39D2180569 - comprehensive outpatient rehab with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/12/2009 and was last updated on 2/12/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101YA0400XCounselorAddiction (Substance Use Disorder)807343PENNSYLVANIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1100728192MEDICAIDPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.