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NPI Code Detail

MEDICARE: SISKIYOU HOSPITAL, INC.

MEDICARE: SISKIYOU HOSPITAL, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center230000035CA
2261QR1300XRural Health Clinic/Center230000035CA
3275N00000XMedicare Defined Swing Bed Hospital Unit230000035CA
4282NC0060XCritical Access Hospital230000035CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4ZZZJ4702ZOTHERCABLUE SHIELD

General Provider Information

NPI Number : 1093892275
Entity Type Code : Organization
Provider Name (Legal Business Name) : SISKIYOU HOSPITAL, INC.
Provider Business Mailing Address
First Line : 444 BRUCE ST
Second Line :
City : YREKA
State : CA
Zip : 96097-3450
Country : US
Telephone Number : 530-842-4121
Fax Number : 530-841-6242
Provider Business Practice Location Address
First Line : 444 BRUCE ST
Second Line :
City : YREKA
State : CA
Zip : 96097-3450
Country : US
Telephone Number : 530-842-4121
Fax Number : 530-841-6242
Authorized Official
Title or Position : CHEIF EXECUTIVE OFFICER
Name : MR. JONATHON C ANDRUS
Credential : CEO
Telephone Number : 530-841-6200
Provider Enumeration Date : 11/01/2006
Last Update Date : 12/14/2015

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Directions to “SISKIYOU HOSPITAL, INC. ” Practice Location

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