| Tracy Occupational Medical Center | |
|
644 W 12th St Tracy CA 95376-3437 | |
| (209) 832-8984 | |
| (209) 832-8988 |
| Full Name | Tracy Occupational Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 644 W 12th St, Tracy, California |
| Authorized Official Name and Position | Jagdish Ambalal Patel (PRESIDENT) |
| Authorized Official Contact | 2098328984 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracy Occupational Medical Center 644 W 12th St Tracy CA 95376-3437 Ph: (209) 832-8984 | Tracy Occupational Medical Center 644 W 12th St Tracy CA 95376-3437 Ph: (209) 832-8984 |
| NPI Number | 1568522878 |
|---|---|
| Provider Enumeration Date | 12/11/2006 |
| Last Update Date | 10/19/2022 |
| Medicare PECOS PAC ID | 6507893104 |
|---|---|
| Medicare Enrollment ID | O20050726000411 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568522878 | NPI | - | NPPES |
| 20A7496 | Other | CA | STATE LICENSE DR. PULLIAM |
| BH8637881 | Other | CA | DR. HUBLI BNDD NUMBER |
| A31816 | Other | CA | STATE LICENSE DR. PATEL |
| 00A85126 | Medicaid | CA | |
| BP4399944 | Other | CA | DR. PULLIAM BNDD NUMBER |
| A855092 | Other | CA | STATE LICENSE DR. HUBLI |
| AP8331112 | Other | CA | DR. PATEL BNDD NUMBER |
| 00A318160 | Medicaid | CA | |
| 05D0695064903593 | Other | CA | CLIA NUMBER |
| AP8331112 | Other | CA | BNDD NUMBER |
| Provider Name | Ian T Pulliam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245262682 PECOS PAC ID: 4486692704 Enrollment ID: I20050418001303 |
| Provider Name | Jagdish A Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407897481 PECOS PAC ID: 0840369344 Enrollment ID: I20081110000502 |
| Provider Name | Ricardo B Echon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821417718 PECOS PAC ID: 4587973177 Enrollment ID: I20151021003060 |
| Provider Name | Jeongsim Kim Izadi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639776933 PECOS PAC ID: 8729441415 Enrollment ID: I20230829000597 |
| Provider Name | Drucilla Adeniran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356073381 PECOS PAC ID: 7719340124 Enrollment ID: I20230901001934 |
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