Healthcare Provider Details

I. General information

NPI: 1306925003
Provider Name (Legal Business Name): CMS MEDICAL CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N 12TH ST
LEHIGHTON PA
18235-1138
US

IV. Provider business mailing address

211 N 12TH ST
LEHIGHTON PA
18235-1138
US

V. Phone/Fax

Practice location:
  • Phone: 610-377-7008
  • Fax: 310-377-7920
Mailing address:
  • Phone: 610-377-7008
  • Fax: 310-377-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRENCE PURCELL
Title or Position: VP/HUMAN RESOURCES
Credential:
Phone: 610-377-7088