| Cedar Medical Clinic | |
|
1595 Soquel Dr Ste 340 Santa Cruz CA 95065-1722 | |
| (831) 425-1279 | |
| (831) 425-3500 |
| Full Name | Cedar Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 1595 Soquel Dr Ste 340, Santa Cruz, California |
| Authorized Official Name and Position | Karl Knudsen Johsen (PHYSICIAN PRESIDENT) |
| Authorized Official Contact | 8314251279 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cedar Medical Clinic 1595 Soquel Dr Ste 340 Santa Cruz CA 95065-1722 Ph: (831) 425-1279 | Cedar Medical Clinic 1595 Soquel Dr Ste 340 Santa Cruz CA 95065-1722 Ph: (831) 425-1279 |
| NPI Number | 1548278534 |
|---|---|
| Provider Enumeration Date | 08/04/2006 |
| Last Update Date | 07/11/2019 |
| Medicare PECOS PAC ID | 8729977301 |
|---|---|
| Medicare Enrollment ID | O20040311001438 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548278534 | NPI | - | NPPES |
| 00G840300 | Other | BLUE SHIELD | |
| CH1649 | Other | GROUP MEDICARE RAILROAD | |
| 110208332 | Other | MEDICARE RAILROAD | |
| 00G840300 | Medicaid | CA | |
| ZZZ62382Z | Other | GROUP BLUE SHIELD CEDAR M | |
| G054030 | Other | CA | BLUE CROSS |
| 610730500 | Other | US DEPT OF LABOR OFFICE O | |
| GR0090740 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | G084030 (California) | Primary |
| Provider Name | Karl Knudsen Johsens |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295948727 PECOS PAC ID: 0446149025 Enrollment ID: I20100806000529 |
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