Heacock Health Medical Group, Inc.
LBN: Heacock Health Medical Group, Inc.
Heacock Health Medical Group, Inc. is an health care organization with primary practice located at 24060 Fir Ave Ste A , Moreno Valley CA 92553-2895. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Ambulatory Health Care Facilities / Urgent Care. Ambulatory Health Care Facilities / Urgent Care is the primary health care specialty.
Heacock Health Medical Group, Inc. can be contacted via phone (951) 242-3025, or through Penunuri, Rafael via phone (951) 242-3025.
Contact Information
Primary practice address
24060 Fir Ave Ste A
Moreno Valley CA 92553-2895
Phone: (951) 242-3025
Fax: (951) 242-3902
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ||
| Ambulatory Health Care Facilities / Urgent Care | 261QU0200X |
Profile Details
| NPI number | 1891251849 |
|---|---|
| LBN Legal business name | Heacock Health Medical Group, Inc. |
| DBA Doing business as | |
| Authorized official | Penunuri, Rafael |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Feb 14th, 2019 |
| Last updated | Feb 14th, 2019 - about 6 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891251849 | NPPES |
| California | MEDICAID | 1760896336 |
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