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716 E Main St Barstow CA 92311-2354 | |
(760) 256-6426 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 716 E Main St, Barstow, California |
Authorized Official Name and Position | Marco A Alfonzo (OFFICE MANAGER) |
Authorized Official Contact | 7609538059 |
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 487 Barstow CA 92312-0487 Ph: (760) 953-8059 | 716 E Main St Barstow CA 92311-2354 Ph: (760) 256-6426 |
NPI Number | 1295745743 |
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Provider Enumeration Date | 08/08/2006 |
Last Update Date | 03/19/2015 |
Medicare PECOS PAC ID | 9931142999 |
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Medicare Enrollment ID | O20050609001081 |
Identifier | Type | State | Issuer |
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1295745743 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | A48518 (California) | Primary |
Provider Name | Mikel A Alwis |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1790705671 PECOS PAC ID: 8527019660 Enrollment ID: I20050204000810 |
Windy City Medical Clinic A Professional Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 525 Melissa Ave Ste A, Barstow, CA 92311 Phone: 760-255-2400 Fax: 760-957-7517 | |
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