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1835 N Broadway Santa Maria CA 93454-1404 | |
(805) 346-2753 | |
(805) 922-2479 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1835 N Broadway, Santa Maria, California |
Authorized Official Name and Position | Barbara A Allen (DIRECTOR OF BUSINESS OFFICE) |
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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150 Tejas Pl Nipomo CA 93444-9123 Ph: (805) 929-3211 | 1835 N Broadway Santa Maria CA 93454-1404 Ph: (805) 346-2753 |
NPI Number | 1851417703 |
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Provider Enumeration Date | 03/22/2007 |
Last Update Date | 12/12/2023 |
Medicare PECOS PAC ID | 7416868120 |
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Medicare Enrollment ID | O20070810000784 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851417703 | NPI | - | NPPES |
ZZZ69714Z | Other | CA | BLUE SHIELD |
CMM71166F | Medicaid | CA | |
W150B | Other | CA | PTAN GROUP # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 550000402 (California) | Primary |
Robert S. Barry Md, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1420 S Miller St Ste A, Santa Maria, CA 93454 Phone: 805-922-3033 | |
Nightingale Medical Group, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1414 S Miller St, Suite 4, Santa Maria, CA 93454 Phone: 805-349-6336 | |