| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 205 N 1st St, Blythe, California |
| Authorized Official Name and Position | Sandra J Anaya (CEO) |
| Authorized Official Contact | 7609224115 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
250 N 1st St Blythe CA 92225-1702 Ph: (760) 922-4115 | 205 N 1st St Blythe CA 92225-1777 Ph: (760) 922-4115 |
| NPI Number | 1740667179 |
|---|---|
| Provider Enumeration Date | 05/06/2015 |
| Last Update Date | 11/26/2024 |
| Medicare PECOS PAC ID | 3678593712 |
|---|---|
| Medicare Enrollment ID | O20051214000926 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740667179 | NPI | - | NPPES |
| ZZT40423H | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Silvia Herrera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447673967 PECOS PAC ID: 0143455758 Enrollment ID: I20180118000876 |
| Provider Name | Stacie Lynn Nellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285720250 PECOS PAC ID: 8123448503 Enrollment ID: I20201023002288 |
| Provider Name | Denise Michelle Beaumont |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1174684260 PECOS PAC ID: 2062807167 Enrollment ID: I20220325001864 |
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