| Organization Name: | MIRIAM MEDICAL CLINICS INC |
| NPI Number: | 1225447592 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANDRA KAY JOHNSON (CFO) |
| Mailing Address: | 2847 N 26th St Philadelphia |
| State: | PA US |
| Postal Code: | 191322508 |
| Phone Number: | 2156448745 |
| Fax Number: | 2156448713 |
| NPI Enumeration Date: | 08/11/2014 |
| NPI Last Update Date: | 12/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |