High Desert Family Medicine | |
44460 Old Hwy 80 Jacumba CA 91934 | |
(619) 766-4071 | |
(619) 766-4128 |
Full Name | High Desert Family Medicine |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 44460 Old Hwy 80, Jacumba, California |
Authorized Official Name and Position | Judith Shaplin (CEO) |
Authorized Official Contact | 6194456200 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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High Desert Family Medicine 31115 Highway 94 Campo CA 91906-3133 Ph: (619) 478-5254 | High Desert Family Medicine 44460 Old Hwy 80 Jacumba CA 91934 Ph: (619) 766-4071 |
NPI Number | 1740358258 |
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Provider Enumeration Date | 12/01/2006 |
Last Update Date | 10/05/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740358258 | NPI | - | NPPES |
FHC53850F | Medicaid | CA | |
HAP53850F | Other | CA | STATE PROGRAM |
BCP53850F | Other | CA | STATE PROGRAM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 090000511 (California) | Primary |