| Mccloud Healthcare Clinic, Inc. | |
|
4309 Stagecoach Road Dunsmuir CA 96025 | |
| (530) 235-4138 | |
| (530) 378-2453 |
| Full Name | Mccloud Healthcare Clinic, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4309 Stagecoach Road, Dunsmuir, California |
| Authorized Official Name and Position | Caleb J Ott (CEO) |
| Authorized Official Contact | 5309642389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mccloud Healthcare Clinic, Inc. Po Box 1143 Mccloud CA 96057-1143 Ph: (530) 964-2389 | Mccloud Healthcare Clinic, Inc. 4309 Stagecoach Road Dunsmuir CA 96025 Ph: (530) 235-4138 |
| NPI Number | 1376893420 |
|---|---|
| Provider Enumeration Date | 09/17/2012 |
| Last Update Date | 11/01/2024 |
| Medicare PECOS PAC ID | 3779494919 |
|---|---|
| Medicare Enrollment ID | O20130110000509 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376893420 | NPI | - | NPPES |
| 00G320960 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | G32096 (California) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 550001195 (California) | Primary |