| Coastal Prestige Medical Services, Inc | |
|
1677 Shell Beach Rd Shell Beach CA 93449-1927 | |
| (805) 201-9135 | |
| (805) 201-9134 |
| Full Name | Coastal Prestige Medical Services, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1677 Shell Beach Rd, Shell Beach, California |
| Authorized Official Name and Position | Johnnie Alan Ham (CEO) |
| Authorized Official Contact | 8052019135 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Prestige Medical Services, Inc 1677 Shell Beach Rd Shell Beach CA 93449-1927 Ph: (805) 201-9135 | Coastal Prestige Medical Services, Inc 1677 Shell Beach Rd Shell Beach CA 93449-1927 Ph: (805) 201-9135 |
| NPI Number | 1518101989 |
|---|---|
| Provider Enumeration Date | 04/28/2009 |
| Last Update Date | 03/12/2020 |
| Medicare PECOS PAC ID | 9335299304 |
|---|---|
| Medicare Enrollment ID | O20090612000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518101989 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A90443 (California) | Primary |
| Provider Name | Johnnie A Ham |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1982687430 PECOS PAC ID: 5193807790 Enrollment ID: I20080204000503 |
Timothy H. Jones, M.d., Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 302 Vista Del Mar Ave, Shell Beach, CA 93449 Phone: 805-236-1277 Fax: 805-625-7091 |