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400 N 17th St Ste 300 Allentown PA 18104-5052 | |
(610) 969-4300 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 400 N 17th St Ste 300, Allentown, Pennsylvania |
Authorized Official Name and Position | Veronica Gonzalez (CEO) |
Authorized Official Contact | 6109692728 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 780631 Philadelphia PA 19178-0631 Ph: (484) 884-4500 | 400 N 17th St Ste 300 Allentown PA 18104-5052 Ph: (610) 969-4300 |
NPI Number | 1912532888 |
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Provider Enumeration Date | 03/11/2020 |
Last Update Date | 09/14/2023 |
Medicare PECOS PAC ID | 4284065327 |
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Medicare Enrollment ID | O20210923001530 |
Identifier | Type | State | Issuer |
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1912532888 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |