| Nepomuceno Hospital Group Inc | |
|
444 Bruce St Yreka CA 96097-3450 | |
| (702) 453-3799 | |
| (702) 453-5741 |
| Full Name | Nepomuceno Hospital Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 444 Bruce St, Yreka, California |
| Authorized Official Name and Position | John Nepomuceno (SOLE OWNER) |
| Authorized Official Contact | 7024533799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nepomuceno Hospital Group Inc Po Box 992337 Redding CA 96099-2337 Ph: (702) 453-3799 | Nepomuceno Hospital Group Inc 444 Bruce St Yreka CA 96097-3450 Ph: (702) 453-3799 |
| NPI Number | 1710334677 |
|---|---|
| Provider Enumeration Date | 05/20/2016 |
| Last Update Date | 05/20/2016 |
| Medicare PECOS PAC ID | 5092008672 |
|---|---|
| Medicare Enrollment ID | O20160719002212 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710334677 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | C50728 (California) | Primary |
| Provider Name | John E Nepomuceno |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477673770 PECOS PAC ID: 9335035708 Enrollment ID: I20040225000245 |
| Provider Name | Carlota Cruz Nepomuceno |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316067622 PECOS PAC ID: 2062308430 Enrollment ID: I20040225000258 |
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