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General NPI Number Information
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NPI Number | 1285036533
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Entity Type | Organization
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Legal Business Name | COLUSA INDIAN COMMUNITY COUNCIL
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 3710 HIGHWAY 45
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City | COLUSA
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State | CA
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Zip | 95932-4026
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Country | US
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Telephone | 530-458-5501
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Fax | 530-458-8660
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Provider Business Mailing Address
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Address Line | 3710 HIGHWAY 45
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City | COLUSA
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State | CA
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Zip | 95932-4026
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MARK SPRAGUE
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Credential |
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Telephone | 530-458-5501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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