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66655 Martinez Rd Thermal CA 92274-9007 | |
(760) 397-4476 | |
(760) 397-0066 |
Full Name | |
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Speciality | Clinic/Center |
Location | 66655 Martinez Rd, Thermal, California |
Authorized Official Name and Position | William Thomsen (CEO) |
Authorized Official Contact | 9098641097 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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11980 Mount Vernon Ave Grand Terrace CA 92313-5172 Ph: (909) 864-1097 | 66655 Martinez Rd Thermal CA 92274-9007 Ph: (760) 397-4476 |
NPI Number | 1043363641 |
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Provider Enumeration Date | 01/19/2007 |
Last Update Date | 09/10/2021 |
Medicare PECOS PAC ID | 4789867805 |
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Medicare Enrollment ID | O20110328000706 |
Identifier | Type | State | Issuer |
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1043363641 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |