Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 510 E. Locust, Lone Pine, California |
Authorized Official Name and Position | Brian F. Cotter (CEO) |
Authorized Official Contact | 7608765501 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1009 Lone Pine CA 93545 Ph: (760) 876-1146 | 510 E. Locust Lone Pine CA 93545 Ph: (760) 876-1146 |
NPI Number | 1063589174 |
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Provider Enumeration Date | 11/30/2006 |
Last Update Date | 01/23/2019 |
Medicare PECOS PAC ID | 7911816731 |
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Medicare Enrollment ID | O20030422000077 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063589174 | NPI | - | NPPES |
05-8511 | Other | CA | MEDICARE ID TYPE UNSPECIFIED |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 240000205 (California) | Primary |