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4723 W Main St Ste H Guadalupe CA 93434-1787 | |
(805) 343-5577 | |
(805) 343-5578 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4723 W Main St Ste H, Guadalupe, California |
Authorized Official Name and Position | Ronald E Castle (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 8053463905 |
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) 361-8028 | 4723 W Main St Ste H Guadalupe CA 93434-1787 Ph: (805) 343-5577 |
NPI Number | 1376560151 |
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Provider Enumeration Date | 07/16/2006 |
Last Update Date | 01/21/2019 |
Medicare PECOS PAC ID | 7416868120 |
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Medicare Enrollment ID | O20040512001225 |
Identifier | Type | State | Issuer |
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1376560151 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |