| Community Medical Centers, Tracy Grant Line | |
|
2151 W Grant Line Rd Tracy CA 95377-7309 | |
| (209) 820-1500 | |
| Not Available |
| Full Name | Community Medical Centers, Tracy Grant Line |
|---|---|
| Speciality | Clinic/Center |
| Location | 2151 W Grant Line Rd, Tracy, California |
| Authorized Official Name and Position | Christine C Noguera (CEO) |
| Authorized Official Contact | 2033732831 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Medical Centers, Tracy Grant Line 7210 Murray Dr Stockton CA 95210-3339 Ph: (209) 373-2800 | Community Medical Centers, Tracy Grant Line 2151 W Grant Line Rd Tracy CA 95377-7309 Ph: (209) 820-1500 |
| NPI Number | 1164919049 |
|---|---|
| Provider Enumeration Date | 04/17/2018 |
| Last Update Date | 04/17/2018 |
| Medicare PECOS PAC ID | 8426968520 |
|---|---|
| Medicare Enrollment ID | O20180620001894 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164919049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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