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15322 Lakeshore Dr Suite 201 Clearlake CA 95422-9814 | |
| (707) 994-2920 | |
| (707) 994-2917 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 15322 Lakeshore Dr, Clearlake, California |
| Authorized Official Name and Position | Kaye A Donnelly (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 7079682809 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1572 Railroad Ave Suite 2 Saint Helena CA 94574-1169 Ph: (707) 968-2809 | 15322 Lakeshore Dr Suite 201 Clearlake CA 95422-9814 Ph: (707) 994-2920 |
| NPI Number | 1346565173 |
|---|---|
| Provider Enumeration Date | 04/05/2010 |
| Last Update Date | 04/05/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346565173 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G45994 (California) | Primary |
Lake County Tribal Health Southshore Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14440 Olympic Drive, Clearlake, CA 95422 Phone: 707-263-8382 Fax: 707-263-5019 | |
Adventist Health Clearlake Hospital, Inc-middletown Family Health Cent Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 18th Ave And Highway 53, Clearlake, CA 95422 Phone: 707-987-3311 Fax: 707-987-2455 | |
Marc R Shapiro Medical Corp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3400 Emerson St, Suite A, Clearlake, CA 95422 Phone: 707-994-7241 Fax: 707-994-0870 | |
Lake County Tribal Health Consortium, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14678 Lakeshore Boulevard, Clearlake, CA 95453 Phone: 707-262-8382 | |