Healthcare Provider Details

I. General information

NPI: 1417032921
Provider Name (Legal Business Name): NORTHERN INYO HEALTHCARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 PIONEER LN STE B
BISHOP CA
93514-2517
US

IV. Provider business mailing address

150 PIONEER LN
BISHOP CA
93514-2556
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-2849
  • Fax: 760-872-5800
Mailing address:
  • Phone: 760-873-5811
  • Fax: 760-872-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number240000179
License Number StateCA

VIII. Authorized Official

Name: MR. CHRISTIAN WALLIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 760-873-2838