| Mid-city Community Clinic | |
|
4290 Polk Ave San Diego CA 92105-1524 | |
| (619) 563-0507 | |
| (619) 563-0015 |
| Full Name | Mid-city Community Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 4290 Polk Ave, San Diego, California |
| Authorized Official Name and Position | Roberta Lee Feinberg (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6195630507 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid-city Community Clinic 4290 Polk Ave San Diego CA 92105-1524 Ph: (619) 563-0507 | Mid-city Community Clinic 4290 Polk Ave San Diego CA 92105-1524 Ph: (619) 563-0507 |
| NPI Number | 1306827332 |
|---|---|
| Provider Enumeration Date | 11/08/2005 |
| Last Update Date | 07/23/2007 |
| Medicare PECOS PAC ID | 9739090937 |
|---|---|
| Medicare Enrollment ID | O20031106000431 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306827332 | NPI | - | NPPES |
| HAP 11882 G | Other | CA | SOFP |
| FHC 11882 G | Other | CA | MEDI-CAL (FQHC) |
| 80406 | Other | CA | HEALTHY FAMILIES |
| W815 | Other | CA | OTHER |
| EAP 11672 F | Other | CA | EXPANDED ACCESS TO PRIMAR |
| BCP 11882 F | Other | CA | BCP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (California) | Primary |
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