CD East Family Health & Wellness Center LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MD418042 Issued in PA

Legal business name

CD EAST FAMILY HEALTH & WELLNESS CENTER LLC

Doing business as

CD East Family Health & Wellness Center

Practice address

845 Sir Thomas CT
Suite 5
Harrisburg, PA 17109-4840

Phone

(717) 695-3704

Fax

(717) 695-7735

NPI assigned

Oct 19, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Angelique McKinney-Bourne, M.D.

Title

Physician/Owner

Phone

(717) 695-3704

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• CD East Family Health & Wellness Center Doing business as

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

{
    "created_epoch": "1255910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274832000000",
    "number": "1710213236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 SIR THOMAS CT",
            "address_2": "SUITE 5",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171094840",
            "telephone_number": "717-695-3704",
            "fax_number": "717-695-7735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 SIR THOMAS CT",
            "address_2": "SUITE 5",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171094840",
            "telephone_number": "717-695-3704",
            "fax_number": "717-695-7735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CD EAST FAMILY HEALTH & WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-19",
        "last_updated": "2010-05-26",
        "status": "A",
        "authorized_official_last_name": "MCKINNEY-BOURNE",
        "authorized_official_first_name": "ANGELIQUE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "717-695-3704",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "PA",
            "license": "MD418042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWNER PERSONAL NPI",
            "identifier": "1942306162",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01784747",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CD East Family Health & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Catlly G Enterprise Inc.
• Catlly G Enterprise Inc.
• Toby Catone, PHYSICIAN ASSISTANT
• Kristen L Cavanaugh, PA-C
• CCN America LP (Coordinated Care Network Pharmacy)
• CDG Harrisburg LLC (Colonial Dental Group)
• CDH Orthodontics, LLC
• CDS Group LLC (STR Behavioral Health - Harrisburg)
• Jessica Lynne Cecco
• Cedar Dialysis LLC (Paxton Dialysis)

• Primary Care Clinic/Center in Harrisburg, PA
• Providers in Harrisburg, PA by specialty
• Primary Care Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; 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.