| Health Care Institute Medical Group | |
|
65 N Madison Ave Ste 709 Pasadena CA 91101-2046 | |
| (626) 792-4185 | |
| (626) 792-7358 |
| Full Name | Health Care Institute Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 65 N Madison Ave Ste 709, Pasadena, California |
| Authorized Official Name and Position | Roy Harper Jackson (PRESIDENT CEO) |
| Authorized Official Contact | 6267924185 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Health Care Institute Medical Group 65 N Madison Ave Ste 709 Pasadena CA 91101-2046 Ph: (626) 792-4185 | Health Care Institute Medical Group 65 N Madison Ave Ste 709 Pasadena CA 91101-2046 Ph: (626) 792-4185 |
| NPI Number | 1659452092 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 04/21/2021 |
| Medicare PECOS PAC ID | 1456395052 |
|---|---|
| Medicare Enrollment ID | O20050614001474 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659452092 | NPI | - | NPPES |
| GR0066950 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | G30184 (California) | Primary |
| Provider Name | Roy Harper Jackson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669424982 PECOS PAC ID: 0143320473 Enrollment ID: I20100317000408 |
| Provider Name | Lillian Winn Ngaw |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154373538 PECOS PAC ID: 4486789369 Enrollment ID: I20100317000482 |
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