MEDICARE: COUNTY OF MONO

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1487770459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF MONO

Provider Business Mailing Address
First Line	:	PO BOX 476
Second Line	:
City	:	BRIDGEPORT
State	:	CA
Zip	:	93517-0476
Country	:	US
Telephone Number	:	760-932-5580
Fax Number	:	760-932-5284

Provider Business Practice Location Address
First Line	:	1290 TAVERN RD STE 246
Second Line	:
City	:	MAMMOTH LAKES
State	:	CA
Zip	:	93546-6603
Country	:	US
Telephone Number	:	760-924-1830
Fax Number	:	760-924-1831

Authorized Official
Title or Position	:	CAO
Name	:	SANDRA MOBERLY
Credential	:
Telephone Number	:	760-932-5414

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/26/2024

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Directions to “COUNTY OF MONO ” Practice Location

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