| Mission City Community Network, Inc. | |
|
405 E Buena Vista St Barstow CA 92311-2815 | |
| (818) 895-3100 | |
| Not Available |
| Full Name | Mission City Community Network, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 405 E Buena Vista St, Barstow, California |
| Authorized Official Name and Position | Nik Gupta (CEO) |
| Authorized Official Contact | 8188953100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mission City Community Network, Inc. 15206 Parthenia St North Hills CA 91343-5305 Ph: () - | Mission City Community Network, Inc. 405 E Buena Vista St Barstow CA 92311-2815 Ph: (818) 895-3100 |
| NPI Number | 1790133379 |
|---|---|
| Provider Enumeration Date | 05/24/2016 |
| Last Update Date | 09/17/2018 |
| Medicare PECOS PAC ID | 1658264684 |
|---|---|
| Medicare Enrollment ID | O20181103000176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790133379 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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