MEDICARE: HILL COUNTRY COMMUNITY CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	230000078	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407914260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILL COUNTRY COMMUNITY CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 228
Second Line	:
City	:	ROUND MOUNTAIN
State	:	CA
Zip	:	96084-0228
Country	:	US
Telephone Number	:	530-337-5750
Fax Number	:	530-337-5754

Provider Business Practice Location Address
First Line	:	29632 HIGHWAY 299 EAST
Second Line	:
City	:	ROUND MOUNTAIN
State	:	CA
Zip	:	96084-0228
Country	:	US
Telephone Number	:	530-337-5750
Fax Number	:	530-337-5754

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JO L CAMPBELL
Credential	:
Telephone Number	:	530-945-3642

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	10/09/2023

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Directions to “HILL COUNTRY COMMUNITY CLINIC ” Practice Location

Language	Start Address	Practice Location

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