| Senior Doc, Tennessee PC | |
|
2592 N Santiago Blvd Orange CA 92867-1862 | |
| (855) 434-7763 | |
| Not Available |
| Full Name | Senior Doc, Tennessee PC |
|---|---|
| Speciality | Family Medicine |
| Location | 2592 N Santiago Blvd, Orange, California |
| Authorized Official Name and Position | John Mark Geiss (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8554347763 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Senior Doc, Tennessee PC 2592 N Santiago Blvd Orange CA 92867-1862 Ph: (855) 434-7763 | Senior Doc, Tennessee PC 2592 N Santiago Blvd Orange CA 92867-1862 Ph: (855) 434-7763 |
| NPI Number | 1568148351 |
|---|---|
| Provider Enumeration Date | 06/26/2023 |
| Last Update Date | 08/01/2023 |
| Certification Date | 08/01/2023 |
| Medicare PECOS PAC ID | 5991169070 |
|---|---|
| Medicare Enrollment ID | O20230907001854 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568148351 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Cherrelle D Matthews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194072686 PECOS PAC ID: 0547504656 Enrollment ID: I20181130000419 |
| Provider Name | John Geiss |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1053651497 PECOS PAC ID: 5890933071 Enrollment ID: I20230919000072 |
| Provider Name | Kellie Marie Pacheco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326728668 PECOS PAC ID: 1951756519 Enrollment ID: I20231017002433 |
| Provider Name | Jeffrey John Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932337136 PECOS PAC ID: 7315101003 Enrollment ID: I20240808002934 |
| Provider Name | Sarah Shah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851050140 PECOS PAC ID: 8426439217 Enrollment ID: I20250905001660 |
| Provider Name | Alexi Yarashevich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306340831 PECOS PAC ID: 6406119304 Enrollment ID: I20260115001452 |
| Provider Name | Anthony Marcus Yniguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871185686 PECOS PAC ID: 2769882331 Enrollment ID: I20260115003613 |
| Provider Name | Daniel John Konchan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356047542 PECOS PAC ID: 9931572302 Enrollment ID: I20260220000786 |
| Provider Name | Robert Charles Morse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356194005 PECOS PAC ID: 0143766287 Enrollment ID: I20260225003220 |
| Provider Name | Meredith Alexandra Bock |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447612940 PECOS PAC ID: 8729339908 Enrollment ID: I20260302001226 |
| Provider Name | Christina Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790499218 PECOS PAC ID: 1759753098 Enrollment ID: I20260311002679 |
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