| Adventist Health Clear Lake | |
|
5290 State St Kelseyville CA 95451-9450 | |
| (707) 279-8813 | |
| (707) 279-2241 |
| Full Name | Adventist Health Clear Lake |
|---|---|
| Speciality | Clinic/Center |
| Location | 5290 State St, Kelseyville, California |
| Authorized Official Name and Position | Judson H.e. Howe (PRESIDENT) |
| Authorized Official Contact | 7074563010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adventist Health Clear Lake Po Box 888837 Los Angeles CA 90088-8837 Ph: () - | Adventist Health Clear Lake 5290 State St Kelseyville CA 95451-9450 Ph: (707) 279-8813 |
| NPI Number | 1962492876 |
|---|---|
| Provider Enumeration Date | 10/24/2005 |
| Last Update Date | 05/29/2024 |
| Medicare PECOS PAC ID | 3072421197 |
|---|---|
| Medicare Enrollment ID | O20100308000333 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962492876 | NPI | - | NPPES |
| ZZZ49286Z | Other | CA | BLUE SHIELD |
| RHM19999G | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 110000174 (California) | Primary |
Kelseyville Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4135 Main St, Kelseyville, CA 95451 Phone: 707-279-2004 Fax: 707-279-2832 |