| |
222 E Olive Ave Ste 5 Redlands CA 92373-5268 | |
(909) 283-4213 | |
(909) 738-4213 |
Full Name | |
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Speciality | Psychiatry & Neurology |
Location | 222 E Olive Ave Ste 5, Redlands, California |
Authorized Official Name and Position | Megan Anderson (PRESIDENT) |
Authorized Official Contact | 9092834213 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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222 E Olive Ave Ste 5 Redlands CA 92373-5268 Ph: (909) 283-4213 | 222 E Olive Ave Ste 5 Redlands CA 92373-5268 Ph: (909) 283-4213 |
NPI Number | 1811604135 |
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Provider Enumeration Date | 11/07/2022 |
Last Update Date | 04/03/2024 |
Certification Date | 04/03/2024 |
Medicare PECOS PAC ID | 4082089586 |
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Medicare Enrollment ID | O20230415000179 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811604135 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
Provider Name | Megan Lynnell Anderson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528442977 PECOS PAC ID: 1456667005 Enrollment ID: I20150827003012 |
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