Healthcare Provider Details

I. General information

NPI: 1821149816
Provider Name (Legal Business Name): SOUTHERN MONO HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 TWIN LAKES ROAD
BRIDGEPORT CA
93517
US

IV. Provider business mailing address

PO BOX 660
MAMMOTH LAKES CA
93546-0660
US

V. Phone/Fax

Practice location:
  • Phone: 760-932-7011
  • Fax: 760-932-7180
Mailing address:
  • Phone: 760-934-3311
  • Fax: 760-924-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number240000008
License Number StateCA

VIII. Authorized Official

Name: MRS. MELANIE VAN WINKLE
Title or Position: CHIEF FINANCIAL OFFI
Credential:
Phone: 760-934-3311