| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 50 Alamo Ave, Weed, California |
| Authorized Official Name and Position | Brandon Watkins (CFO) |
| Authorized Official Contact | 5309999010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 277 Bieber CA 96009-0277 Ph: (530) 999-9010 | 50 Alamo Ave Weed CA 96094-2352 Ph: (530) 999-9050 |
| NPI Number | 1073018305 |
|---|---|
| Provider Enumeration Date | 03/28/2018 |
| Last Update Date | 07/28/2023 |
| Medicare PECOS PAC ID | 4284685538 |
|---|---|
| Medicare Enrollment ID | O20180531001148 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073018305 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Lake Shastina Medical Clinic Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 16337 Everhart Dr, Weed, CA 96094 Phone: 530-938-2297 Fax: 530-938-0494 | |
Shasta Regional Medical Group, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 50 Alamo Ave, Weed, CA 96094 Phone: 530-605-4263 |