NPIMap

Organization Active NPI

Mill Medical Clinic Inc

  • Primary Care Clinic/Center
  • San Bernardino, CA
National Provider Identifier
1710074877
Registry record updated Aug 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
A383760 Issued in CA
Legal business name
MILL MEDICAL CLINIC INC
Doing business as
Mill Medical Clinic
Practice address
1292 W Mill St
Suite 105
San Bernardino, CA 92410-2500
Phone
(909) 383-9440
Fax
(909) 383-9443
NPI assigned
Oct 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Paul C Kintanar
Title
Office Manager
Phone
(909) 253-0841

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X A383760 CA Primary

Addresses

Primary practice location

1292 W Mill St
Suite 105
San Bernardino, CA 92410-2500

Mailing address

1292 W Mill St
Suite 105
San Bernardino, CA 92410-2500
Phone (909) 253-0841

Other identifiers 3

IdentifierTypeStateIssuer
00A383760MedicaidCA
00A383761MedicaidCA
GR0078010MedicaidCA

Other names 1

  • Mill Medical Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

1292 W Mill St
Ste 105
Sn Bernrdno, CA 92410
Phone (909) 253-0841

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408579200000",
    "number": "1710074877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 W MILL ST",
            "address_2": "SUITE 105",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924102500",
            "telephone_number": "909-253-0841",
            "fax_number": "909-521-7154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1292 W MILL ST",
            "address_2": "SUITE 105",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924102500",
            "telephone_number": "909-383-9440",
            "fax_number": "909-383-9443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILL MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2014-08-21",
        "status": "A",
        "authorized_official_last_name": "KINTANAR",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "909-253-0841",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A383760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A383760",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A383761",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0078010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mill Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.