| Sutter Lakeside Community Health Center | |
|
750 Old Lucerne Road Upper Lake CA 95485-0000 | |
| (707) 275-9066 | |
| (707) 275-9070 |
| Full Name | Sutter Lakeside Community Health Center |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 750 Old Lucerne Road, Upper Lake, California |
| Authorized Official Name and Position | Brian Trent Hunter (VP SHARED SERVICES) |
| Authorized Official Contact | 9162978555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sutter Lakeside Community Health Center Po Box 742412 Los Angeles CA 90074-2412 Ph: (415) 600-7120 | Sutter Lakeside Community Health Center 750 Old Lucerne Road Upper Lake CA 95485-0000 Ph: (707) 275-9066 |
| NPI Number | 1629301775 |
|---|---|
| Provider Enumeration Date | 09/08/2009 |
| Last Update Date | 01/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629301775 | NPI | - | NPPES |
| RKY18547F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 110000094 (California) | Primary |
Milan L Hopkins, M.d., A Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9425 Main St, Upper Lake, CA 95485 Phone: 707-275-2366 Fax: 707-275-9043 |