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1111 N China Lake Blvd Ridgecrest CA 93555-3131 | |
| (760) 499-3855 | |
| (760) 499-3870 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1111 N China Lake Blvd, Ridgecrest, California |
| Authorized Official Name and Position | James A Suver (CEO) |
| Authorized Official Contact | 7604993900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1081 N China Lake Blvd Ridgecrest CA 93555-3130 Ph: (760) 499-3902 | 1111 N China Lake Blvd Ridgecrest CA 93555-3131 Ph: (760) 499-3855 |
| NPI Number | 1972813087 |
|---|---|
| Provider Enumeration Date | 10/08/2010 |
| Last Update Date | 04/13/2022 |
| Certification Date | 04/13/2022 |
| Medicare PECOS PAC ID | 9739099896 |
|---|---|
| Medicare Enrollment ID | O20090819000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972813087 | NPI | - | NPPES |
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