| Scvmc Renal Care Center | |
|
2220 Moorpark Ave Scvmc Renal Care Center San Jose CA 95128-2613 | |
| (408) 885-5000 | |
| Not Available |
| Full Name | Scvmc Renal Care Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2220 Moorpark Ave, San Jose, California |
| Authorized Official Name and Position | Paul E Lorenz (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4088854010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Scvmc Renal Care Center Po Box 103331 Pasadena CA 91189-3331 Ph: (669) 299-8165 | Scvmc Renal Care Center 2220 Moorpark Ave Scvmc Renal Care Center San Jose CA 95128-2613 Ph: (408) 885-5000 |
| NPI Number | 1972679850 |
|---|---|
| Provider Enumeration Date | 11/24/2006 |
| Last Update Date | 10/11/2023 |
| Medicare PECOS PAC ID | 1254244973 |
|---|---|
| Medicare Enrollment ID | O20210607002922 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972679850 | NPI | - | NPPES |
| CG5995 | Other | CA | RR MEDICARE |
| HSP40038F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 070000085 (California) | Secondary |
| 261QE0700X | Clinic/center - End-stage Renal Disease (esrd) Treatment | 070000085 (California) | Primary |
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