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1385 Mission St San Miguel CA 93451 | |
(805) 467-2344 | |
(805) 467-2334 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1385 Mission St, San Miguel, California |
Authorized Official Name and Position | Ronald E Castle (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 8053618014 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2050 S Blosser Rd Santa Maria CA 93458-7310 Ph: (805) 361-8014 | 1385 Mission St San Miguel CA 93451 Ph: (805) 467-2344 |
NPI Number | 1295198356 |
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Provider Enumeration Date | 04/05/2016 |
Last Update Date | 01/21/2019 |
Medicare PECOS PAC ID | 7416868120 |
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Medicare Enrollment ID | O20180102001471 |
Identifier | Type | State | Issuer |
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1295198356 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |