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21337 Bush Street Middletown CA 95461 | |
(707) 987-3311 | |
(707) 987-2455 |
Full Name | |
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Speciality | Family Medicine |
Location | 21337 Bush Street, Middletown, California |
Authorized Official Name and Position | Judson H.e. Howe (PRESIDENT) |
Authorized Official Contact | 7074563010 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 888837 Los Angeles CA 90088-8837 Ph: () - | 21337 Bush Street Middletown CA 95461 Ph: (707) 987-3311 |
NPI Number | 1063791028 |
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Provider Enumeration Date | 08/09/2011 |
Last Update Date | 05/29/2024 |
Identifier | Type | State | Issuer |
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1063791028 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Lake County Tribal Health Middletown Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 22223 Ca-29, Rancheria Road, Tribal Offices #1035, Middletown, CA 95461 Phone: 707-263-8382 |