Occidental Area Health Center | |
3802 Main Street Occidental CA 95464 | |
(707) 874-2444 | |
(707) 874-1664 |
Full Name | Occidental Area Health Center |
---|---|
Speciality | Clinic/Center |
Location | 3802 Main Street, Occidental, California |
Authorized Official Name and Position | Tari M Wallace (BILLING DIRECTOR) |
Authorized Official Contact | 7078695977 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Occidental Area Health Center Po Box 1449 Guerneville CA 95446-1449 Ph: (707) 874-2444 | Occidental Area Health Center 3802 Main Street Occidental CA 95464 Ph: (707) 874-2444 |
NPI Number | 1598768962 |
---|---|
Provider Enumeration Date | 05/31/2005 |
Last Update Date | 01/23/2008 |
Medicare PECOS PAC ID | 6800782277 |
---|---|
Medicare Enrollment ID | O20110908001832 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598768962 | NPI | - | NPPES |
HAP03899G | Other | CA | FPACT |
ZZZ23666Z | Other | CA | BLUE SHIELD PIN |
FHC03899G | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (California) | Primary |