| Stanislaus County Health Services Agency Mchenry Medical Office | |
|
1209 Woodrow Ave Ste. B-10 Modesto CA 95350-1288 | |
| (209) 558-5312 | |
| (209) 558-8611 |
| Full Name | Stanislaus County Health Services Agency Mchenry Medical Office |
|---|---|
| Speciality | Clinic/Center |
| Location | 1209 Woodrow Ave, Modesto, California |
| Authorized Official Name and Position | Mary Ann Lee (MANAGING DIRECTOR) |
| Authorized Official Contact | 2095587163 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stanislaus County Health Services Agency Mchenry Medical Office 1209 Woodrow Ave Ste. B-10 Modesto CA 95350-1288 Ph: (209) 558-5312 | Stanislaus County Health Services Agency Mchenry Medical Office 1209 Woodrow Ave Ste. B-10 Modesto CA 95350-1288 Ph: (209) 558-5312 |
| NPI Number | 1093910275 |
|---|---|
| Provider Enumeration Date | 06/18/2007 |
| Last Update Date | 10/03/2024 |
| Medicare PECOS PAC ID | 0648183996 |
|---|---|
| Medicare Enrollment ID | O20071016000365 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093910275 | NPI | - | NPPES |
| CMM70751F | Other | CA | MEDICAL |
| HAP70751F | Other | CA | FAMILY PACT |
| FHC70751F | Other | MEDICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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