MEDICARE: SURPRISE VALLEY HEALTH CARE DISTRICT

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	261QE0002X	Emergency Care Clinic/Center	230000025	CA
2	261QR0200X	Radiology Clinic/Center	230000025	CA
3	282N00000X	General Acute Care Hospital	230000025	CA
4	291U00000X	Clinical Medical Laboratory	230000025	CA
5	3416L0300X	Land Ambulance	230000025	CA
6	282NC0060X	Critical Access Hospital	230000025	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801973052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURPRISE VALLEY HEALTH CARE DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 246
Second Line	:	741 NORTH MAIN
City	:	CEDARVILLE
State	:	CA
Zip	:	96104-0246
Country	:	US
Telephone Number	:	530-279-6111
Fax Number	:	530-279-2680

Provider Business Practice Location Address
First Line	:	741 MAIN & WASHINGTON
Second Line	:
City	:	CEDARVILLE
State	:	CA
Zip	:	96104-0246
Country	:	US
Telephone Number	:	530-279-6111
Fax Number	:	530-279-2680

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	WANDA L. GROVE
Credential	:
Telephone Number	:	530-279-6111

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/28/2011

Similar Medicare Providers

1023194222 — SURPRISE VALLEY HEALTH CARE DISTRICT
Practice Location Address:

741 NORTH MAIN ST
CEDARVILLE, CA
96104-0246

Practice Phone: 530-279-6111
Practice Fax: 530-279-2680

1073693651 — SURPRISE VALLEY HEALTH CARE DISTRICT
Practice Location Address:

745 MAIN STREET
CEDARVILLE, CA
96104

Practice Phone: 530-279-6111
Practice Fax: 530-279-2680

1700963956 — SURPRISE VALLEY HOSPITAL DISTRICT
Practice Location Address:

741 N MAIN , MAIN & WASHINGTON ST
CEDARVILLE, CA
96104

Practice Phone: 530-279-6111
Practice Fax: 530-279-2680

1093843930 — DR. LENI KAREN SINCLAIR
Practice Location Address:

HC 1 BOX 11B
CEDARVILLE, CA
96104-9601

Practice Phone: 530-279-2052
Practice Fax: 775-367-1106

1750829925 — PAFFORD HEALTH
Practice Location Address:

519A MAIN STREET
CEDARVILLE, CA
96104

Practice Phone: 530-279-2148
Practice Fax: 530-240-6440

1861022873 — CHUCK R. COLAS, D.O., P.C.
Practice Location Address:

#66, COUNTY RD. 37 #6
CEDARVILLE, CA
96104

Practice Phone: 314-888-5233
Practice Fax: 203-590-8644

Directions to “SURPRISE VALLEY HEALTH CARE DISTRICT ” Practice Location

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