Shasta Lake Family Health & Dental Center is a medicare enrolled dental clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in Shasta Lake, California. The current practice location for Shasta Lake Family Health & Dental Center is 4215 Front St, Shasta Lake, California. For appointments, you can reach them via phone at
(530) 246-5896. The mailing address for Shasta Lake Family Health & Dental Center is Po Box 992790, Redding, California and phone number is (530) 246-5896.
Shasta Lake Family Health & Dental Center is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its
NPI number is 1013932797. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(530) 246-5896.
Dental Care Clinic Profile
| Full Name | Shasta Lake Family Health & Dental Center |
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| Speciality | Clinic/Center |
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| Location | 4215 Front St, Shasta Lake, California |
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| Authorized Official Name and Position | Jeffery Brandon Thornock (CEO) |
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| Authorized Official Contact | 5302465074 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Shasta Lake Family Health & Dental Center
Po Box 992790
Redding
CA 96099-2790
Ph: (530) 246-5896 | Shasta Lake Family Health & Dental Center
4215 Front St
Shasta Lake
CA 96019-9430
Ph: (530) 246-5896 |
NPI Details:
| NPI Number | 1013932797 |
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| Provider Enumeration Date | 07/13/2006 |
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| Last Update Date | 10/16/2024 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 3870579816 |
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| Medicare Enrollment ID | O20100625000635 |
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Medical Identifiers
Medical identifiers for Shasta Lake Family Health & Dental Center such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1013932797 | NPI | - | NPPES |
| FHC70877F | Other | CA | SCHC-SLC MEDI-CAL NUMBER |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 122300000X | Dentist | 230000325 (California) | Secondary |
| 207Q00000X | Family Medicine | 230000325 (California) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 363AM0700X | Physician Assistant - Medical | 230000325 (California) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 230000325 (California) | Secondary |
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