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88775 Avenue 76 Ste. 1 Thermal CA 92274 | |
(760) 397-2501 | |
(760) 397-2508 |
Full Name | |
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Speciality | Clinic/Center |
Location | 88775 Avenue 76, Thermal, California |
Authorized Official Name and Position | Judy Stith (CHIEF ADMINISTRATIVE OFFICER) |
Authorized Official Contact | 7603232118 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1695 N. Sunrise Way Palm Springs CA 92262 Ph: (760) 323-2118 | 88775 Avenue 76 Ste. 1 Thermal CA 92274 Ph: (760) 397-2501 |
NPI Number | 1255490819 |
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Provider Enumeration Date | 12/08/2006 |
Last Update Date | 07/10/2024 |
Medicare PECOS PAC ID | 6002989522 |
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Medicare Enrollment ID | O20240410003439 |
Identifier | Type | State | Issuer |
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1255490819 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (California) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |