| Shine Medical Providers Pc | |
|
709 N 2nd St Ste 400 Philadelphia PA 19123-3108 | |
| (888) 380-2028 | |
| Not Available |
| Full Name | Shine Medical Providers Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 709 N 2nd St Ste 400, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Clare Frances Boals Frye (SVP OF OPERATIONS) |
| Authorized Official Contact | 6166481196 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shine Medical Providers Pc Po Box 360721 Pittsburgh PA 15251-6721 Ph: () - | Shine Medical Providers Pc 709 N 2nd St Ste 400 Philadelphia PA 19123-3108 Ph: (888) 380-2028 |
| NPI Number | 1538894050 |
|---|---|
| Provider Enumeration Date | 07/19/2022 |
| Last Update Date | 10/04/2024 |
| Certification Date | 10/04/2024 |
| Medicare PECOS PAC ID | 3577094861 |
|---|---|
| Medicare Enrollment ID | O20240926003276 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538894050 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Christopher R Dennis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811068349 PECOS PAC ID: 5092709402 Enrollment ID: I20240926003259 |
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