=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831128602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN INYO HEALTHCARE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 01/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 E. LOCUST STREET
-----------------------------------------------------
City | LONE PINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-876-5501
-----------------------------------------------------
Fax | 760-876-4388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1009
-----------------------------------------------------
City | LONE PINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93545-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-876-5501
-----------------------------------------------------
Fax | 760-876-4388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | PETER SPIERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-876-5501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 240000205
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 240000205
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 240000205
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------