| Adventist Health Clear Lake | |
|
21337 Bush St Middletown CA 95461 | |
| (707) 987-3311 | |
| (707) 987-2455 |
| Full Name | Adventist Health Clear Lake |
|---|---|
| Speciality | Clinic/Center |
| Location | 21337 Bush St, Middletown, 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 21337 Bush St Middletown CA 95461 Ph: (707) 987-3311 |
| NPI Number | 1972593788 |
|---|---|
| Provider Enumeration Date | 10/24/2005 |
| Last Update Date | 05/29/2024 |
| Medicare PECOS PAC ID | 3072421197 |
|---|---|
| Medicare Enrollment ID | O20021226000021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972593788 | NPI | - | NPPES |
| RHM08586F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 110000174 (California) | Primary |
Adventist Health Clear Lake Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 21337 Bush Street, Middletown, CA 95461 Phone: 707-987-3311 Fax: 707-987-2455 |