Provider Demographics
NPI:1497925994
Name:MONTEBELLO MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:MONTEBELLO MEDICAL CENTER INC.
Other - Org Name:MONTEBELLO MEDICAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-728-7998
Mailing Address - Street 1:229 E BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3776
Mailing Address - Country:US
Mailing Address - Phone:323-728-7998
Mailing Address - Fax:323-728-5041
Practice Address - Street 1:229 E BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3776
Practice Address - Country:US
Practice Address - Phone:323-728-7998
Practice Address - Fax:323-728-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG39251BMedicare UPIN
CAS051220Medicare PIN