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6065 State Hwy 193 Georgetown CA 95634-9623 | |
(530) 333-2555 | |
(530) 333-2832 |
Full Name | |
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Speciality | Clinic/Center |
Location | 6065 State Hwy 193, Georgetown, California |
Authorized Official Name and Position | Laurie Eldridge (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 5306262780 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 45680 San Fransisco CA 94145-0680 Ph: (530) 333-2555 | 6065 State Hwy 193 Georgetown CA 95634-9623 Ph: (530) 333-2555 |
NPI Number | 1346226693 |
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Provider Enumeration Date | 12/19/2005 |
Last Update Date | 09/08/2020 |
Medicare PECOS PAC ID | 7517875859 |
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Medicare Enrollment ID | O20090729000462 |
Identifier | Type | State | Issuer |
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1346226693 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |