| Impact Care Access Network Inc | |
|
9390 Hesperia Rd Suite # 7 Hesperia CA 92345-3602 | |
| (760) 998-2125 | |
| (760) 948-0723 |
| Full Name | Impact Care Access Network Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9390 Hesperia Rd, Hesperia, California |
| Authorized Official Name and Position | Philip Dimitrios Kouros (MEDICAL DOCTOR) |
| Authorized Official Contact | 7609484219 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Care Access Network Inc 9390 Hesperia Rd Suite # 7 Hesperia CA 92345-3602 Ph: (760) 998-2125 | Impact Care Access Network Inc 9390 Hesperia Rd Suite # 7 Hesperia CA 92345-3602 Ph: (760) 998-2125 |
| NPI Number | 1861858904 |
|---|---|
| Provider Enumeration Date | 01/05/2016 |
| Last Update Date | 01/05/2016 |
| Medicare PECOS PAC ID | 3375810930 |
|---|---|
| Medicare Enrollment ID | O20170601002682 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861858904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | G69428 (California) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | G69428 (California) | Secondary |
| Provider Name | Philip D Kouros |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972608677 PECOS PAC ID: 7012811060 Enrollment ID: I20031121000505 |
| Provider Name | Nathan B Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548345473 PECOS PAC ID: 0840209946 Enrollment ID: I20060418000689 |
| Provider Name | Lisa L Banks |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1992945885 PECOS PAC ID: 3870627649 Enrollment ID: I20100816000405 |
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