| Shiloh Medical Center Inc | |
|
12332 Hesperia Rd Ste A Victorville CA 92395 | |
| (760) 243-4009 | |
| (760) 243-3255 |
| Full Name | Shiloh Medical Center Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 12332 Hesperia Rd, Victorville, California |
| Authorized Official Name and Position | Charmaine E Earle (PRESIDENT) |
| Authorized Official Contact | 7602434009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shiloh Medical Center Inc 12332 Hesperia Rd Ste A Victorville CA 92395 Ph: (760) 243-4009 | Shiloh Medical Center Inc 12332 Hesperia Rd Ste A Victorville CA 92395 Ph: (760) 243-4009 |
| NPI Number | 1245333830 |
|---|---|
| Provider Enumeration Date | 09/07/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2163456377 |
|---|---|
| Medicare Enrollment ID | O20050926001173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245333830 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Charmaine E Earle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598833303 PECOS PAC ID: 8325072531 Enrollment ID: I20050927000157 |
| Provider Name | Tere-monique Oresa Carrington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376006544 PECOS PAC ID: 0648668533 Enrollment ID: I20211026001892 |
| Provider Name | Alvenia Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174281208 PECOS PAC ID: 0749641215 Enrollment ID: I20230731003113 |
| Provider Name | Judith K Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588364640 PECOS PAC ID: 7012379795 Enrollment ID: I20230811001630 |
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