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155 S 5th St Coalinga CA 93210-1903 | |
(559) 587-4349 | |
(559) 587-4366 |
Full Name | |
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Speciality | Clinic/Center |
Location | 155 S 5th St, Coalinga, California |
Authorized Official Name and Position | Andrea Kofl (CENTRAL VALLEY NETWORK PRESIDENT) |
Authorized Official Contact | 5595370056 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 888806 Los Angeles CA 90088-8806 Ph: (559) 587-4349 | 155 S 5th St Coalinga CA 93210-1903 Ph: (559) 587-4349 |
NPI Number | 1972586386 |
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Provider Enumeration Date | 11/21/2005 |
Last Update Date | 04/08/2022 |
Medicare PECOS PAC ID | 0941460984 |
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Medicare Enrollment ID | O20151016002270 |
Identifier | Type | State | Issuer |
---|---|---|---|
1972586386 | NPI | - | NPPES |
HAP08596F | Medicaid | CA | |
BCP08596F | Medicaid | CA | |
RHM08596F | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 040000140 (California) | Primary |