| Heather Stone Medical Clinic | |
|
900 N Heritage Dr Bldg E Ridgecrest CA 93555-5536 | |
| (760) 446-4571 | |
| Not Available |
| Full Name | Heather Stone Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 900 N Heritage Dr, Ridgecrest, California |
| Authorized Official Name and Position | Douglas Emanuel Roberts (PRESIDENT) |
| Authorized Official Contact | 7604464571 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heather Stone Medical Clinic 900 N Heritage Dr Bldg E Ridgecrest CA 93555-5536 Ph: (760) 446-4571 | Heather Stone Medical Clinic 900 N Heritage Dr Bldg E Ridgecrest CA 93555-5536 Ph: (760) 446-4571 |
| NPI Number | 1386899268 |
|---|---|
| Provider Enumeration Date | 11/19/2008 |
| Last Update Date | 10/30/2014 |
| Medicare PECOS PAC ID | 8921154592 |
|---|---|
| Medicare Enrollment ID | O20090923000324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386899268 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Douglas E Roberts |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508869926 PECOS PAC ID: 9537231261 Enrollment ID: I20080711000385 |
| Provider Name | David P Lusk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831193408 PECOS PAC ID: 4385716026 Enrollment ID: I20080711000457 |
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