FORT BIDWELL INDIAN COMMUNITY NPI 1093931107

NPI Information

FORT BIDWELL INDIAN COMMUNITY is a rural health clinic center in Fort Bidwell, CA. FORT BIDWELL INDIAN COMMUNITY NPI is 1093931107. The provider is registered as an organization entity type.
The provider Other Name Is Warner Mountain Indian Health Project.

The provider's business location address is:

132 MEE THEE UH ROAD
FORT BIDWELL, CA
ZIP 96112
Phone: (530) 279-6194
Fax: (530) 279-6288

The provider's authorized official is Candice Dawn Russell .
The authorized official title is Clinic Manager and has the following contact phone number (530) 279-6194.

The CLIA number assigned to this NPI record is 05D0692143 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/17/2007 and was last updated on 7/2/2008.

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:

Other Identifiers

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