=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073990925
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASTERN PLUMAS HEALTH CARE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2015
-----------------------------------------------------
Last Update Date | 07/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 N PINE ST
-----------------------------------------------------
City | PORTOLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96122-8415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-832-6500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 1ST AVE
-----------------------------------------------------
City | PORTOLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96122-9406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-832-6500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | THOMAS HAYES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-832-6564
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 230000014
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------