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NPI Code Detail

MEDICARE: PIONEERS MEMORIAL HEALTHCARE DISTRICT

MEDICARE: PIONEERS MEMORIAL HEALTHCARE DISTRICT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR1300XRural Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZC1301ZOTHERCABLUE SHIELD RHC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4058607OTHERCABLUE CROSS RHC

General Provider Information

NPI Number : 1437122769
Entity Type Code : Organization
Provider Name (Legal Business Name) : PIONEERS MEMORIAL HEALTHCARE DISTRICT
Provider Business Mailing Address
First Line : 207 W LEGION RD
Second Line :
City : BRAWLEY
State : CA
Zip : 92227-7780
Country : US
Telephone Number : 760-351-3590
Fax Number : 760-351-3312
Provider Business Practice Location Address
First Line : 450 E BIRCH ST
Second Line :
City : CALEXICO
State : CA
Zip : 92231-2375
Country : US
Telephone Number : 760-768-6262
Fax Number :
Authorized Official
Title or Position : ASSOCIATE ADMIN FINANCE & CFO
Name : MR. DANIEL R HECKATHORNE
Credential :
Telephone Number : 760-351-3590
Provider Enumeration Date : 02/08/2006
Last Update Date : 12/28/2007

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Directions to “PIONEERS MEMORIAL HEALTHCARE DISTRICT ” Practice Location

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