| Central Square Medical Center - Grant Ave | |
|
9501 Roosevelt Blvd Suite 206-b Philadelphia PA 19114-1025 | |
| (215) 671-8900 | |
| (215) 671-1272 |
| Full Name | Central Square Medical Center - Grant Ave |
|---|---|
| Speciality | Family Medicine |
| Location | 9501 Roosevelt Blvd, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Ronald M. Kumor (SENIOR VICE PRESIDENT) |
| Authorized Official Contact | 2156124858 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Square Medical Center - Grant Ave Po Box 825395 Philadelphia PA 19182-5395 Ph: (215) 671-8900 | Central Square Medical Center - Grant Ave 9501 Roosevelt Blvd Suite 206-b Philadelphia PA 19114-1025 Ph: (215) 671-8900 |
| NPI Number | 1316072077 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 10/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316072077 | NPI | - | NPPES |
| 1007526250039 | Medicaid | PA | |
| 1007526250051 | Medicaid | PA | |
| 10236 | Other | PA | HEALTH PARTNERS |
| 1007526250041 | Medicaid | PA | |
| 1026492 | Other | PA | KEYSTONE MERCY |
| 19933 | Other | PA | AETNA |
| 379777 | Other | PA | HIGHMARK BLUE SHIELD |
| 379777 | Other | PA | PERSONAL CHOICE |
| 0200976001 | Other | PA | KEYSTONE, IBC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Pennsylvania) | Primary |
| 207R00000X | Internal Medicine | (Pennsylvania) | Secondary |
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University Of Penn - Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3400 Spruce St, 3 Ravdin, Suite F, Pulmonary & Critical Care, Philadelphia, PA 19104 Phone: 215-662-3202 | |
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