Full Name | |
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Speciality | Clinic/Center |
Location | 2120 Cienaga, Oceano, California |
Authorized Official Name and Position | Barbara Allen (BUSINESS OFFICE MANGER) |
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 | 2120 Cienaga Oceano CA 93445-9029 Ph: (805) 994-2100 |
NPI Number | 1417480294 |
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Provider Enumeration Date | 04/07/2017 |
Last Update Date | 01/23/2019 |
Medicare PECOS PAC ID | 7416868120 |
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Medicare Enrollment ID | O20170912003291 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417480294 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |