MORNINGSIDE PRIMARY CARE MEDICAL CTR, INC (NPI# 1083643837) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083643837 |
| Entity Type | Organization |
| Organization Name | MORNINGSIDE PRIMARY CARE MEDICAL CTR, INC |
| Practice Address |
1704 W Manchester Ave Suite 101 Los Angeles CA 90047-3034 |
| Practice Telephone | 3237786215 |
| Practice Fax Number | 3237786312 |
| Mailing Telephone | 3237786215 |
| Mailing Fax Number | 3237786312 |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2014-12-17 |
| Authorized Official Name | MR. LEMMON C MCMILLAN (PRESIDENT) |
| Authorized Official Telephone | 3237786215 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0059700 | 05 |
| Street Address |
1704 W MANCHESTER AVE SUITE 101 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90047-3034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225662331 | Erika Hall | Case Manager/Care Coordinator | 1704 W Manchester Ave, Los Angeles, CA 90047-3063 | 2020-02-27 |
| 1083177372 | Jessica Bessette | Nurse Practitioner | 1704 W Manchester Ave, Los Angeles, CA 90047-3063 | 2019-04-12 |
| 1053707182 | Pacific Coast Medical Supply | Durable Medical Equipment & Medical Supplies | 1704 W Manchester Ave, Suite 105, Los Angeles, CA 90047-3063 | 2015-04-15 |
| 1245637362 | God's Property Sober Living Foundation | Substance Abuse Rehabilitation Facility | 1704 W Manchester Ave, Suite 210, Los Angeles, CA 90047-3063 | 2014-12-04 |
| 1851702286 | Morningside Specialty Hospital Inc. | Special Hospital | 1704 W Manchester Ave, Suite 206k, Los Angeles, CA 90047-3063 | 2014-05-20 |
| 1053722256 | Loving Touch Hospice Care, Inc. | Hospice Care, Community Based | 1704 W Manchester Ave, Suite 101-d, Los Angeles, CA 90047-3063 | 2014-05-11 |
| 1982023628 | Jahreese Barber | Counselor | 1704 W Manchester Ave, Suite 203, Los Angeles, CA 90047-3063 | 2014-04-09 |
| 1245655745 | Brighter Beginnings Drug and Alcohol Rehabilitation Facility | Community/Behavioral Health | 1704 W Manchester Ave, Los Angeles, CA 90047-3063 | 2014-02-20 |
| 1518236017 | Nueva Esperanza Healthcare Medical Clinic Inc. | Family Medicine | 1704 W Manchester Ave, Suite 109, Los Angeles, CA 90047-3063 | 2011-12-29 |
| 1063781565 | Nueva Esperanza Healthcare Medical Clinic Inc. | Family Medicine | 1704 W Manchester Ave, Suite 109, Los Angeles, CA 90047-3063 | 2011-12-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063071652 | Cherae Nikia Stovall | Counselor | 1704 Manchester Boulevard, Suite 202, Los Angeles, CA 90047 | 2019-06-07 |
| 1598264053 | Dignity Health | Community/Behavioral Health | 1852 W Imperial Hwy, Los Angeles, CA 90047 | 2018-02-09 |
| 1750805222 | Brian George Martinez | Counselor | 1448 W 83rd St, Los Angeles, CA 90047 | 2017-07-27 |
| 1295266609 | Maria Amezcua | Rehabilitation Practitioner | 108 W Victoria Street, Gardena, CA 90047 | 2017-03-27 |
| 1265861140 | Ameika Porter | Counselor | 1529 West 82nd Street, Los Angeles, CA 90047 | 2013-11-01 |
| 1053747519 | Maria D Macias | Counselor | 11601 S. Western Avenue, Los Angeles, CA 90047 | 2013-09-16 |
| 1366704132 | Evelyn Carolina Hernandez | Family Medicine | 1555 West 110th Street, Los Angeles, CA 90047 | 2012-06-08 |
| 1003057142 | Sandra Patricia Trim | Licensed Vocational Nurse | 2048 W 69 St, Los Angeles, CA 90047 | 2009-03-19 |
| 1194962001 | Estuardo Ardon | Counselor | 11603 S. Western Ave., Los Angeles, CA 90047 | 2009-01-14 |
| 1174788400 | Frenda Brigette Williams | Dentist | 2015 W 81st St, Los Angeles, CA 90047 | 2008-07-25 |
| Find all providers in zip 90047 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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| 1104470384 | Chan Family Medical Corp | General Practice | 4070 E. Olympic Blvd, Los Angeles, CA 90023 | 2019-07-26 |
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| 1942767801 | Plaza Health Services Inc. | General Practice | 11111 Santa Monica Blvd Ste 200, Los Angeles, CA 90025-3333 | 2019-02-27 |
| 1124536289 | Edward Meltser | General Practice | 469 N Alfred St, Los Angeles, CA 90048-2504 | 2018-01-11 |
| 1023524980 | St. Johns Urgent Care & Medical Corporation | General Practice | 1138 N Western Ave, Los Angeles, CA 90029-1702 | 2017-12-14 |
| 1992234199 | David Ghods | General Practice | 3631 Crenshaw Blvd Ste 109, Los Angeles, CA 90016-4869 | 2017-06-09 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90047 |
Please comment or provide details below to improve the information on MORNINGSIDE PRIMARY CARE MEDICAL CTR, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.