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31115 Highway 94 Campo CA 91906-3133 | |
(619) 478-5311 | |
(619) 478-2267 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 31115 Highway 94, Campo, California |
Authorized Official Name and Position | Judith Shaplin (CEO) |
Authorized Official Contact | 6194456200 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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31115 Highway 94 Campo CA 91906-3133 Ph: (619) 478-5254 | 31115 Highway 94 Campo CA 91906-3133 Ph: (619) 478-5311 |
NPI Number | 1881752608 |
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Provider Enumeration Date | 12/05/2006 |
Last Update Date | 05/08/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881752608 | NPI | - | NPPES |
HAP03814F | Other | CA | STATE PROGRAM |
FHC03814F | Medicaid | CA | |
BCP03814F | Other | CA | STATE PROGRAM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 090000135 (California) | Primary |
Centro De Salud De La Comunidad De San Ysidro, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1388 Buckman Springs Rd, Campo, CA 91906 Phone: 619-662-4100 | |
Mountain Health & Community Services, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1388 Buckman Springs Rd, Campo, CA 91906 Phone: 619-478-5254 Fax: 619-478-9164 |