LAKE COUNTY TRIBAL HEALTH SOUTHSHORE CLINIC NPI 1063158038

NPI Information

NPI: 1063158038
Provider Name: LAKE COUNTY TRIBAL HEALTH SOUTHSHORE CLINIC
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
14440 OLYMPIC DRIVE
CLEARLAKE, CA
ZIP 95422
Phone: (707) 263-8382
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LAKE COUNTY TRIBAL HEALTH SOUTHSHORE CLINIC is a federally qualified health center (fqhc) clinic center in Clearlake, CA. LAKE COUNTY TRIBAL HEALTH SOUTHSHORE CLINIC NPI is 1063158038. The provider is registered as an organization entity type.

The provider's business location address is:

14440 OLYMPIC DRIVE
CLEARLAKE, CA
ZIP 95422
Phone: (707) 263-8382
Fax: (707) 263-5019

The provider's authorized official is Ernesto Padilla .
The authorized official title is Ceo and has the following contact phone number (707) 263-8382.

The enumeration date for this NPI number is 5/11/2022 and was last updated on 4/2/2024.

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)			Yes

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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