Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 191 E Polk St., Coalinga, 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 |
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Po Box 580 Lemoore CA 93245-0580 Ph: (559) 386-4500 | 191 E Polk St. Coalinga CA 93210 Ph: (559) 386-4500 |
NPI Number | 1669019139 |
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Provider Enumeration Date | 12/04/2019 |
Last Update Date | 07/10/2024 |
Medicare PECOS PAC ID | 5597782144 |
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Medicare Enrollment ID | O20200317002674 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669019139 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |