| Adventist Health Clearlake Hospital Inc. | |
|
21337 Bush St Middletown CA 95461 | |
| (707) 987-3311 | |
| (707) 987-2455 |
| Full Name | Adventist Health Clearlake Hospital Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 21337 Bush St, Middletown, California |
| Authorized Official Name and Position | Parker J Pridgen (PRESIDENT) |
| Authorized Official Contact | 7074675200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adventist Health Clearlake Hospital Inc. Po Box 888837 Los Angeles CA 90088-8837 Ph: () - | Adventist Health Clearlake Hospital Inc. 21337 Bush St Middletown CA 95461 Ph: (707) 987-3311 |
| NPI Number | 1972593788 |
|---|---|
| Provider Enumeration Date | 10/24/2005 |
| Last Update Date | 09/15/2025 |
| Medicare PECOS PAC ID | 3072421197 |
|---|---|
| Medicare Enrollment ID | O20021226000021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972593788 | NPI | - | NPPES |
| RHM08586F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 110000174 (California) | Primary |
Lake County Tribal Health Middletown Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 22223 Ca-29, Rancheria Road, Tribal Offices #1035, Middletown, CA 95461 Phone: 707-263-8382 |