Healthcare Provider Details

I. General information

NPI: 1376902692
Provider Name (Legal Business Name): K'IMA:W MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 AIRPORT RD
HOOPA CA
95546-9615
US

IV. Provider business mailing address

535 AIRPORT RD
HOOPA CA
95546-9615
US

V. Phone/Fax

Practice location:
  • Phone: 530-625-4261
  • Fax:
Mailing address:
  • Phone: 530-625-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberRHF00101325
License Number StateCA

VIII. Authorized Official

Name: MR. EMMETT CHASE
Title or Position: CEO
Credential:
Phone: 530-625-4261