Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 23001 Ca-96, Weitchpec, California |
Authorized Official Name and Position | Cecil Paul Wilson (CFO) |
Authorized Official Contact | 7078254065 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1600 Weeot Way Arcata CA 95521-4734 Ph: (707) 825-5000 | 23001 Ca-96 Weitchpec CA 95546 Ph: (530) 625-4300 |
NPI Number | 1265438154 |
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Provider Enumeration Date | 06/24/2005 |
Last Update Date | 12/22/2023 |
Certification Date | 12/21/2023 |
Medicare PECOS PAC ID | 9830085075 |
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Medicare Enrollment ID | O20090408000471 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265438154 | NPI | - | NPPES |