| Nhclv-bethlehem | |
|
1210 E 4th St Fowler Family Center Bethlehem PA 18015-2016 | |
| (610) 849-9157 | |
| Not Available |
| Full Name | Nhclv-bethlehem |
|---|---|
| Speciality | Clinic/Center |
| Location | 1210 E 4th St, Bethlehem, Pennsylvania |
| Authorized Official Name and Position | Melissa Miranda Craig (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6108207605 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nhclv-bethlehem 635 E Broad St Bethlehem PA 18018-6332 Ph: (610) 820-7605 | Nhclv-bethlehem 1210 E 4th St Fowler Family Center Bethlehem PA 18015-2016 Ph: (610) 849-9157 |
| NPI Number | 1326418245 |
|---|---|
| Provider Enumeration Date | 10/05/2015 |
| Last Update Date | 07/07/2022 |
| Medicare PECOS PAC ID | 2961537352 |
|---|---|
| Medicare Enrollment ID | O20170417000211 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326418245 | NPI | - | NPPES |
| 391039 | Other | PA | MEDICARE CERTIFICATION NUMBER PART A |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | OS015738 (Pennsylvania) | Primary |
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