1831128602 NPI number — SOUTHERN INYO HEALTHCARE DISTRICT

Table of content: (NPI 1831128602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831128602 NPI number — SOUTHERN INYO HEALTHCARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN INYO HEALTHCARE DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHERN INYO HEALTHCARE DISTRICT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831128602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1009
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONE PINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93545-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-876-5501
Provider Business Mailing Address Fax Number:
760-876-4388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 E. LOCUST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONE PINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-876-5501
Provider Business Practice Location Address Fax Number:
760-876-4388
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPIERS
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
760-876-5501

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  240000205 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 240000205 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 240000205 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZT30388F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC55527F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MTN01039F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM18511F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT40388F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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