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NPI Code Detail

MEDICARE: SOUTHERN MONO HEALTH CARE DISTRICT

MEDICARE: SOUTHERN MONO 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
1261QC0050XCritical Access Hospital Clinic/Center240000008CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962444059
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN MONO HEALTH CARE DISTRICT
Provider Business Mailing Address
First Line : PO BOX 660
Second Line : 85 SIERRA PARK RD.
City : MAMMOTH LAKES
State : CA
Zip : 93546
Country : US
Telephone Number : 760-934-3311
Fax Number : 760-924-4149
Provider Business Practice Location Address
First Line : 85 SIERRA PARK RD
Second Line :
City : MAMMOTH LAKES
State : CA
Zip : 93546-2073
Country : US
Telephone Number : 760-934-3311
Fax Number : 760-924-4149
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MRS. MELANIE VAN WINKLE
Credential :
Telephone Number : 760-934-3311
Provider Enumeration Date : 06/12/2006
Last Update Date : 02/25/2022

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Directions to “SOUTHERN MONO HEALTH CARE DISTRICT ” Practice Location

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