| Central Coast Id Consultants | |
|
1551 Bishop St Ste 250 San Luis Obispo CA 93401-4661 | |
| (805) 540-0689 | |
| (805) 541-1376 |
| Full Name | Central Coast Id Consultants |
|---|---|
| Speciality | Internal Medicine |
| Location | 1551 Bishop St Ste 250, San Luis Obispo, California |
| Authorized Official Name and Position | J Trees Ritter (PRESIDENT) |
| Authorized Official Contact | 8053055296 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Coast Id Consultants Po Box 1206 Goleta CA 93116-1206 Ph: (805) 540-0689 | Central Coast Id Consultants 1551 Bishop St Ste 250 San Luis Obispo CA 93401-4661 Ph: (805) 540-0689 |
| NPI Number | 1679772867 |
|---|---|
| Provider Enumeration Date | 07/17/2007 |
| Last Update Date | 12/13/2023 |
| Medicare PECOS PAC ID | 3274634035 |
|---|---|
| Medicare Enrollment ID | O20070723000803 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679772867 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 20A8407 (California) | Primary |
| Provider Name | Jethro T Ritter |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1457330797 PECOS PAC ID: 3072503127 Enrollment ID: I20040512001340 |
| Provider Name | Christopher V Holland |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1063492031 PECOS PAC ID: 0345278917 Enrollment ID: I20050803001195 |
| Provider Name | Gregory Scott Canfield |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1144632159 PECOS PAC ID: 8426345869 Enrollment ID: I20160928001288 |
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