Healthcare Provider Details

I. General information

NPI: 1497258610
Provider Name (Legal Business Name): SOUTHERN MONO HEALTHCARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 S MAIN ST
BISHOP CA
93514-3415
US

IV. Provider business mailing address

PO BOX 660
MAMMOTH LAKES CA
93546-0660
US

V. Phone/Fax

Practice location:
  • Phone: 760-872-7766
  • Fax:
Mailing address:
  • Phone: 760-934-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELANIE L VAN WINKLE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 760-924-4012