| Antelope Valley Community Clinic - Mobile Health Clinic I | |
|
45104 10th St W Lancaster CA 93534-2310 | |
| (661) 942-2391 | |
| (661) 902-6839 |
| Full Name | Antelope Valley Community Clinic - Mobile Health Clinic I |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 45104 10th St W, Lancaster, California |
| Authorized Official Name and Position | James A. Cook (CEO) |
| Authorized Official Contact | 6619422391 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Antelope Valley Community Clinic - Mobile Health Clinic I 45074 10th St W Suite 109 Lancaster CA 93534-2371 Ph: (661) 942-2391 | Antelope Valley Community Clinic - Mobile Health Clinic I 45104 10th St W Lancaster CA 93534-2310 Ph: (661) 942-2391 |
| NPI Number | 1710199674 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 09/12/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710199674 | NPI | - | NPPES |
| CMM70633H | Other | CA | MEDI-CAL |
| CT556A | Other | CA | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 060000428 (California) | Primary |
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