SISKIYOU COMMUNITY HEALTH CENTER INC. NPI 1841438231

NPI Information

NPI: 1841438231
Provider Name: SISKIYOU COMMUNITY HEALTH CENTER, INC.

Other Name: EVERGREEN ELEMENTARY SBHC

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 38D2075164

Address:
520 W RIVER ST
CAVE JUNCTION, OR
ZIP 97523
Phone: (541) 592-6491
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SISKIYOU COMMUNITY HEALTH CENTER, INC. is a federally qualified health center (fqhc) clinic center in Cave Junction, OR. SISKIYOU COMMUNITY HEALTH CENTER, INC. NPI is 1841438231. The provider is registered as an organization entity type.
The provider Other Name Is Evergreen Elementary Sbhc.

The provider's business location address is:

520 W RIVER ST
CAVE JUNCTION, OR
ZIP 97523-504
Phone: (541) 592-6491
Fax: (541) 592-6489

The provider's authorized official is Richard Booth .
The authorized official title is Ceo and has the following contact phone number (541) 471-3455.

The CLIA number assigned to this NPI record is 38D2075164 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/23/2009 and was last updated on 10/6/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	127725	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	127725	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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