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MT SHASTA MEDI-CAL CLINIC INC NPI 1679514483


NPI Information

NPI: 1679514483
Provider Name: MT SHASTA MEDI-CAL CLINIC, INC

Doing Business As: ALPINE HEALTHCARE

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
912 PINE ST
MOUNT SHASTA, CA
ZIP 96067
Phone: (530) 926-5105
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MT SHASTA MEDI-CAL CLINIC, INC is a rural health clinic center in Mount Shasta, CA. MT SHASTA MEDI-CAL CLINIC, INC NPI is 1679514483. The provider is registered as an organization entity type.
The provider Is Doing Business As Alpine Healthcare.

The provider's business location address is:

912 PINE ST
MOUNT SHASTA, CA
ZIP 96067-143
Phone: (530) 926-5105
Fax: (530) 926-1359

The provider's authorized official is Chris Bayless .
The authorized official title is Executive Director and has the following contact phone number (530) 926-5105.

The enumeration date for this NPI number is 6/10/2006 and was last updated on 8/4/2009.


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
1261QR1300XClinic/CenterRural Health230000075CALIFORNIAYes

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
1553856MEDICARE OSCAR/CERTIFICATIONCALIFORNIA
2EAP53856FOTHERCALIFORNIAEAP
3RHM53856FMEDICAIDCALIFORNIA

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

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