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501 N Indian Rd Smith River CA 95567-9509 | |
(707) 487-0215 | |
(707) 487-3003 |
Full Name | |
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Speciality | Clinic/Center |
Location | 501 N Indian Rd, Smith River, 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 | 501 N Indian Rd Smith River CA 95567-9509 Ph: (707) 487-0215 |
NPI Number | 1821440371 |
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Provider Enumeration Date | 07/08/2016 |
Last Update Date | 07/14/2022 |
Certification Date | 07/14/2022 |
Medicare PECOS PAC ID | 9830085075 |
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Medicare Enrollment ID | O20170508000273 |
Identifier | Type | State | Issuer |
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1821440371 | NPI | - | NPPES |