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9279 Locust Street Plymouth CA 95669 | |
(209) 245-6968 | |
(209) 245-5135 |
Full Name | |
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Speciality | Clinic/Center |
Location | 9279 Locust Street, Plymouth, California |
Authorized Official Name and Position | Krista Lopes (SH VP, QUALITY, SAFETY AND PATIENT) |
Authorized Official Contact | 9163847544 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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P.o. Box 255228 Sacramento CA 95825 Ph: (866) 681-0736 | 9279 Locust Street Plymouth CA 95669 Ph: (209) 245-6968 |
NPI Number | 1831467653 |
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Provider Enumeration Date | 12/07/2011 |
Last Update Date | 04/25/2024 |
Medicare PECOS PAC ID | 9830094515 |
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Medicare Enrollment ID | O20120417000401 |
Identifier | Type | State | Issuer |
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1831467653 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (California) | Primary |