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1041 N. China Lake Blvd. Ridgecrest CA 93555-3130 | |
| (760) 446-3551 | |
| (760) 446-2254 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1041 N. China Lake Blvd., Ridgecrest, California |
| Authorized Official Name and Position | James A Suver (CEO) |
| Authorized Official Contact | 7604993900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1081 N. China Lake Blvd. Ridgecrest CA 93555-3130 Ph: (760) 446-3551 | 1041 N. China Lake Blvd. Ridgecrest CA 93555-3130 Ph: (760) 446-3551 |
| NPI Number | 1639448400 |
|---|---|
| Provider Enumeration Date | 12/22/2011 |
| Last Update Date | 07/13/2023 |
| Medicare PECOS PAC ID | 9739099896 |
|---|---|
| Medicare Enrollment ID | O20200716002532 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639448400 | NPI | - | NPPES |
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