| |
304 Becky Pease Street Kettleman City CA 93239 | |
(559) 386-4501 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 304 Becky Pease Street, Kettleman City, California |
Authorized Official Name and Position | John Blaine (CEO) |
Authorized Official Contact | 5599258800 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 580 Lemoore CA 93245-0580 Ph: (559) 386-4500 | 304 Becky Pease Street Kettleman City CA 93239 Ph: (559) 386-4501 |
NPI Number | 1275918674 |
---|---|
Provider Enumeration Date | 07/27/2015 |
Last Update Date | 07/10/2024 |
Medicare PECOS PAC ID | 5597782144 |
---|---|
Medicare Enrollment ID | O20160216001618 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275918674 | NPI | - | NPPES |
751844 | Other | CA | MEDICARE OSCAR CERTIFICATION |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |