| Bill Moore Community Health Clinic | |
|
1460 N Lake Ave Pasadena CA 91104-2300 | |
| (626) 398-3796 | |
| (626) 398-3895 |
| Full Name | Bill Moore Community Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1460 N Lake Ave, Pasadena, California |
| Authorized Official Name and Position | Al Sorkin (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6263983796 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bill Moore Community Health Clinic 1460 N Lake Ave P.o. Box 41274 Pasadena CA 91104-2300 Ph: (626) 398-3796 | Bill Moore Community Health Clinic 1460 N Lake Ave Pasadena CA 91104-2300 Ph: (626) 398-3796 |
| NPI Number | 1114963642 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1759319197 |
|---|---|
| Medicare Enrollment ID | O20050727001174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114963642 | NPI | - | NPPES |
| CMM70645F | Medicaid | CA | |
| W16126 | Other | PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | CMM70645F (California) | Primary |
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