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498 Main Street Tulelake CA 96134-0725 | |
(530) 999-9060 | |
(530) 667-2562 |
Full Name | |
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Speciality | Clinic/Center |
Location | 498 Main Street, Tulelake, California |
Authorized Official Name and Position | Brandon Watkins (CFO) |
Authorized Official Contact | 5309999010 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 277 Bieber CA 96009-0277 Ph: (530) 999-9010 | 498 Main Street Tulelake CA 96134-0725 Ph: (530) 999-9060 |
NPI Number | 1679645121 |
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Provider Enumeration Date | 11/13/2006 |
Last Update Date | 07/28/2023 |
Medicare PECOS PAC ID | 4284685538 |
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Medicare Enrollment ID | O20111213000896 |
Identifier | Type | State | Issuer |
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1679645121 | NPI | - | NPPES |
1679645121 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |