| Pine Street Clinic | |
|
408 Pine St Mount Shasta CA 96067-2126 | |
| (530) 926-6111 | |
| (530) 926-0517 |
| Full Name | Pine Street Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 408 Pine St, Mount Shasta, California |
| Authorized Official Name and Position | Kim Miranda (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5302256121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Street Clinic 3400 Data Dr 1st Floor Rancho Cordova CA 95670-7956 Ph: (530) 225-6300 | Pine Street Clinic 408 Pine St Mount Shasta CA 96067-2126 Ph: (530) 926-6111 |
| NPI Number | 1942632534 |
|---|---|
| Provider Enumeration Date | 08/06/2013 |
| Last Update Date | 10/31/2016 |
| Medicare PECOS PAC ID | 2062320559 |
|---|---|
| Medicare Enrollment ID | O20131212001321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942632534 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (NU) | Primary |
Shasta Cascade Health Centers- Mt Shasta Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 824 Pine St, Mount Shasta, CA 96067 Phone: 530-926-4528 |
Elizabeth Stelz D O Inc a Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 914 Pine St, Mount Shasta, CA 96067 Phone: 530-926-6111 |
Good Medicine a Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 Old Mccloud Rd, Mount Shasta, CA 96067 Phone: 530-926-5100 Fax: 530-926-1859 |
Richard Ingle MD Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 914 Pine St, Mount Shasta, CA 96067 Phone: 775-304-7237 Fax: 530-926-7134 |
Mt Shasta Hospitalist Services Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 914 Pine St, Mount Shasta, CA 96067 Phone: 530-926-6111 |
Shasta Cascade Health Centers- Mt Shasta 822 Pine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 822 Pine St, Mount Shasta, CA 96067 Phone: 530-926-6309 Fax: 530-926-5070 |