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General NPI Number Information
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NPI Number | 1922090885
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Entity Type | Organization
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Legal Business Name | SOUTHERN INDIAN HEALTH COUNCIL
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 36350 CHURCH ROAD
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City | CAMPO
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State | CA
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Zip | 91906-2715
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Country | US
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Telephone | 619-445-1188
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Fax | 619-659-3140
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Provider Business Mailing Address
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Address Line | 4058 WILLOWS ROAD
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City | ALPINE
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State | CA
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Zip | 91901-1668
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Country | US
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Telephone | 619-445-1188
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Fax | 619-659-3138
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Authorized Official
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Title or Position | CFO
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Name | TERRANCE A KING
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Credential |
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Telephone | 619-445-1188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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