Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 150 Tejas Pl, Nipomo, California |
Authorized Official Name and Position | Barbara Allen (BUSINESS OFFICE MANAGER) |
Authorized Official Contact | 8053618014 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
2050 S Blosser Rd Santa Maria CA 93458-7310 Ph: (805) 361-8014 | 150 Tejas Pl Nipomo CA 93444-9123 Ph: (805) 929-3211 |
NPI Number | 1841217866 |
---|---|
Provider Enumeration Date | 07/16/2006 |
Last Update Date | 01/23/2019 |
Medicare PECOS PAC ID | 7416868120 |
---|---|
Medicare Enrollment ID | O20100614000123 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841217866 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |