Broadway Medical Clinic | |
1351 Broadway El Cajon CA 92021-5811 | |
(619) 383-6703 | |
(866) 473-3324 |
Full Name | Broadway Medical Clinic |
---|---|
Speciality | Internal Medicine |
Location | 1351 Broadway, El Cajon, California |
Authorized Official Name and Position | Jimi Ola Benson (PRESIDENT) |
Authorized Official Contact | 3014661078 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Broadway Medical Clinic 1351 Broadway El Cajon CA 92021-5811 Ph: (619) 383-6703 | Broadway Medical Clinic 1351 Broadway El Cajon CA 92021-5811 Ph: (619) 383-6703 |
NPI Number | 1275936270 |
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Provider Enumeration Date | 10/03/2014 |
Last Update Date | 02/07/2022 |
Medicare PECOS PAC ID | 3173845005 |
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Medicare Enrollment ID | O20141204001162 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275936270 | NPI | - | NPPES |
1477751667 | Medicaid | CA | |
1275936270 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | A116611 (California) | Primary |
Provider Name | Jimi O Benson |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1477751667 PECOS PAC ID: 7315111408 Enrollment ID: I20111130000256 |
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