Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 190 11th St, Oakland, California |
Authorized Official Name and Position | Dong W Suh (CHIEF OF OPERATION OFFICER) |
Authorized Official Contact | 5107353110 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
101 8th St Ste 100 Oakland CA 94607-4707 Ph: (510) 735-3110 | 190 11th St Oakland CA 94607-4878 Ph: (510) 250-8300 |
NPI Number | 1821501792 |
---|---|
Provider Enumeration Date | 11/14/2017 |
Last Update Date | 12/17/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821501792 | NPI | - | NPPES |
1447391719 | Medicaid | CA | |
1821501792 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 140000666 (California) | Primary |
Roosevelt School-based Behavioral Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1926 E 19th St, Oakland, CA 94606 Phone: 510-535-4000 | |
Oakland Medical Group, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 424 28th St, Oakland, CA 94609 Phone: 510-452-4824 Fax: 510-465-4503 | |
Treble Health, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 490 43rd St Unit 106, Oakland, CA 94609 Phone: 800-865-3142 | |
Randall Healthcare Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 350 30th St, #100, Oakland, CA 94609 Phone: 510-342-2239 Fax: 510-380-7143 |