| Santa Rosa Indian Health Clinic | |
|
65175 St. Highway 74 Mountain Center CA 92561-9231 | |
| (951) 823-8882 | |
| (951) 225-6879 |
| Full Name | Santa Rosa Indian Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 65175 St. Highway 74, Mountain Center, California |
| Authorized Official Name and Position | William Thomsen (CEO) |
| Authorized Official Contact | 9098641097 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Santa Rosa Indian Health Clinic 11980 Mount Vernon Ave Grand Terrace CA 92313-5172 Ph: (909) 864-1097 | Santa Rosa Indian Health Clinic 65175 St. Highway 74 Mountain Center CA 92561-9231 Ph: (951) 823-8882 |
| NPI Number | 1366028086 |
|---|---|
| Provider Enumeration Date | 03/23/2021 |
| Last Update Date | 09/16/2021 |
| Medicare PECOS PAC ID | 4789867805 |
|---|---|
| Medicare Enrollment ID | O20220912001768 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366028086 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Riverside/san Bernardino County Indian Health, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 65175 State Highway 74, Mountain Center, CA 92561 Phone: 951-823-8882 |