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NPI Code Detail

MEDICARE: MENDOCINO COMMUNITY HEALTH CLINIC, INC.

MEDICARE: MENDOCINO COMMUNITY HEALTH CLINIC, INC.
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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1EAP03933FOTHERCAEAPC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3HAP03933FOTHERCAFAMILY PACT

General Provider Information

NPI Number : 1811958952
Entity Type Code : Organization
Provider Name (Legal Business Name) : MENDOCINO COMMUNITY HEALTH CLINIC, INC.
Provider Business Mailing Address
First Line : 333 LAWS AVE
Second Line :
City : UKIAH
State : CA
Zip : 95482-6540
Country : US
Telephone Number : 707-468-1010
Fax Number : 707-468-0174
Provider Business Practice Location Address
First Line : 333 LAWS AVE
Second Line :
City : UKIAH
State : CA
Zip : 95482-6540
Country : US
Telephone Number : 707-468-1010
Fax Number : 707-468-0174
Authorized Official
Title or Position : BILLING MANAGER
Name : MRS. ANTONIA DELGADO VEGA
Credential :
Telephone Number : 707-467-2260
Provider Enumeration Date : 03/29/2006
Last Update Date : 05/07/2019

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1336218718 — SAM FERNANDEZ LCSW
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333 LAWS AVE
UKIAH, CA
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1821167586 — VIRGINIA MEEK DDS
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1942379391 — JUSTIN EBERT P.A.
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Directions to “MENDOCINO COMMUNITY HEALTH CLINIC, INC. ” Practice Location

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