| Penscott Medical Corporation | |
|
4165 Blackhawk Plaza Cir #250 Danville CA 94506-4904 | |
| (925) 736-8510 | |
| (925) 736-2491 |
| Full Name | Penscott Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 4165 Blackhawk Plaza Cir, Danville, California |
| Authorized Official Name and Position | John William Roberts (PRESIDENT) |
| Authorized Official Contact | 9257368510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Penscott Medical Corporation 4165 Blackhawk Plaza Cir #250 Danville CA 94506-4904 Ph: (925) 736-8510 | Penscott Medical Corporation 4165 Blackhawk Plaza Cir #250 Danville CA 94506-4904 Ph: (925) 736-8510 |
| NPI Number | 1316038920 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4587658703 |
|---|---|
| Medicare Enrollment ID | O20040412000796 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316038920 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G53582 (California) | Primary |
| Provider Name | Pamela Mcdonald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255311809 PECOS PAC ID: 8729072400 Enrollment ID: I20040414000751 |
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