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100 Horseshoe Lane Weaverville CA 96093 | |
| (530) 623-8888 | |
| (530) 623-8887 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 100 Horseshoe Lane, Weaverville, California |
| Authorized Official Name and Position | Heather Aultman (COO) |
| Authorized Official Contact | 7077645617 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 7 Scotia CA 95565-0007 Ph: (707) 764-5617 | 100 Horseshoe Lane Weaverville CA 96093 Ph: (530) 623-8888 |
| NPI Number | 1255898953 |
|---|---|
| Provider Enumeration Date | 02/28/2019 |
| Last Update Date | 08/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255898953 | NPI | - | NPPES |
| ZZZ80700Z | Other | CA | MEDICARE PIN |
| RHM70040F | Medicaid | CA | |
| 051026 | Medicaid | CA | |
| FHC70040F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Donald E. Krouse, M.d., Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 560 Main Street, Weaverville, CA 96093 Phone: 530-623-3735 Fax: 530-623-1196 |