| Morongo Indian Health | |
|
11555 1/2 Potrero Rd Banning CA 92220-6946 | |
| (951) 849-4761 | |
| (951) 849-5612 |
| Full Name | Morongo Indian Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 11555 1/2 Potrero Rd, Banning, California |
| Authorized Official Name and Position | William Thomsen (CEO) |
| Authorized Official Contact | 9098641097 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Morongo Indian Health 11980 Mount Vernon Ave Grand Terrace CA 92313-5172 Ph: (909) 864-1097 | Morongo Indian Health 11555 1/2 Potrero Rd Banning CA 92220-6946 Ph: (951) 849-4761 |
| NPI Number | 1437202124 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 08/25/2021 |
| Medicare PECOS PAC ID | 4789867805 |
|---|---|
| Medicare Enrollment ID | O20110329000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437202124 | NPI | - | NPPES |
| FHC03854F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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