Healthcare Provider Details

I. General information

NPI: 1063589174
Provider Name (Legal Business Name): SOUTHERN INYO HEALTHCARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E. LOCUST
LONE PINE CA
93545
US

IV. Provider business mailing address

PO BOX 1009
LONE PINE CA
93545
US

V. Phone/Fax

Practice location:
  • Phone: 760-876-1146
  • Fax: 760-876-4046
Mailing address:
  • Phone: 760-876-1146
  • Fax: 760-876-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number240000205
License Number StateCA

VIII. Authorized Official

Name: MR. BRIAN F. COTTER
Title or Position: CEO
Credential: R.N.
Phone: 760-876-5501