Provider Demographics
NPI:1043780661
Name:MEDICAL COMPLETE CARE CLINIC
Entity Type:Organization
Organization Name:MEDICAL COMPLETE CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-419-8088
Mailing Address - Street 1:910 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1904
Mailing Address - Country:US
Mailing Address - Phone:610-419-8088
Mailing Address - Fax:610-419-8088
Practice Address - Street 1:910 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1904
Practice Address - Country:US
Practice Address - Phone:610-419-8088
Practice Address - Fax:610-419-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty