| Good Samaritan Community Health Center | |
|
482 Corona Mall Corona CA 92879-1418 | |
| (951) 642-2974 | |
| Not Available |
| Full Name | Good Samaritan Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 482 Corona Mall, Corona, California |
| Authorized Official Name and Position | Mowbray Hagan (CEO) |
| Authorized Official Contact | 9516422974 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Good Samaritan Community Health Center 482 Corona Mall Corona CA 92879-1418 Ph: () - | Good Samaritan Community Health Center 482 Corona Mall Corona CA 92879-1418 Ph: (951) 642-2974 |
| NPI Number | 1639807985 |
|---|---|
| Provider Enumeration Date | 08/12/2022 |
| Last Update Date | 08/12/2022 |
| Medicare PECOS PAC ID | 3476909474 |
|---|---|
| Medicare Enrollment ID | O20231027000523 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639807985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Mowbray P Hagan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235145590 PECOS PAC ID: 1052376365 Enrollment ID: I20050325000640 |
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