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6171 S. Daniels Ave Tranquility CA 93668 | |
(559) 693-2462 | |
(559) 693-4382 |
Full Name | |
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Speciality | Clinic/Center |
Location | 6171 S. Daniels Ave, Tranquility, California |
Authorized Official Name and Position | Cindy Simonic (BILLING MANAGER) |
Authorized Official Contact | 5593642938 |
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 737 San Joaquin CA 93660-0737 Ph: (559) 693-2462 | 6171 S. Daniels Ave Tranquility CA 93668 Ph: (559) 693-2462 |
NPI Number | 1407347941 |
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Provider Enumeration Date | 05/21/2018 |
Last Update Date | 11/02/2020 |
Medicare PECOS PAC ID | 2365588902 |
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Medicare Enrollment ID | O20210426002414 |
Identifier | Type | State | Issuer |
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1407347941 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |