| San Manuel Indian Health | |
|
11980 Mount Vernon Ave Grand Terrace CA 92313-5172 | |
| (909) 864-1097 | |
| (909) 744-3960 |
| Full Name | San Manuel Indian Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 11980 Mount Vernon Ave, Grand Terrace, California |
| Authorized Official Name and Position | William Thomsen (CEO) |
| Authorized Official Contact | 9098641097 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Manuel Indian Health 11980 Mount Vernon Ave Grand Terrace CA 92313-5172 Ph: (909) 864-1097 | San Manuel Indian Health 11980 Mount Vernon Ave Grand Terrace CA 92313-5172 Ph: (909) 864-1097 |
| NPI Number | 1174676670 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 08/25/2021 |
| Medicare PECOS PAC ID | 4789867805 |
|---|---|
| Medicare Enrollment ID | O20110428000118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174676670 | NPI | - | NPPES |
| FHC03869F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 240000751 (California) | Primary |
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Riverside-san Bernardino County Indian Health, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11980 Mount Vernon Ave, Grand Terrace, CA 92313 Phone: 909-864-1097 Fax: 951-252-6879 | |
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Sasn Manuel Indian Health Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11980 Mount Vernon Ave, Grand Terrace, CA 92313 Phone: 909-864-1097 |