| St. Mary Medical Center C.a.r.e. Program | |
|
1043 Elm Ave Long Beach CA 90813-3271 | |
| (562) 624-4900 | |
| (562) 491-9128 |
| Full Name | St. Mary Medical Center C.a.r.e. Program |
|---|---|
| Speciality | Clinic/center |
| Location | 1043 Elm Ave, Long Beach, California |
| Authorized Official Name and Position | Rachel Smith (CHIEF FINANCIAL OFFICER (INTERIM)) |
| Authorized Official Contact | 5624919929 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Mary Medical Center C.a.r.e. Program 1043 Elm Ave Suite 300 Long Beach CA 90813-3271 Ph: (562) 624-4906 | St. Mary Medical Center C.a.r.e. Program 1043 Elm Ave Long Beach CA 90813-3271 Ph: (562) 624-4900 |
| NPI Number | 1619092046 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 09/23/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619092046 | NPI | - | NPPES |
| ZZZA0191Z | Other | CA | BLUE SHIELD |
| ZZT40191H | Medicaid | CA | |
| 870692255 | Other | CA | IRS |
| AYD000290 | Medicaid | CA | |
| 0022013 | Other | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 930000012 (California) | Primary |
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