MEDICARE: COUNTY OF HUMBOLDT

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
1	261QP2400X	Prison Health Clinic/Center

General Provider Information

NPI Number	:	1952169104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF HUMBOLDT

Provider Business Mailing Address
First Line	:	901 5TH ST
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501-1108
Country	:	US
Telephone Number	:	707-441-5101
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 5TH ST
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501-1108
Country	:	US
Telephone Number	:	707-441-5101
Fax Number	:

Authorized Official
Title or Position	:	LIEUTENANT
Name	:	DENNIS GRIFFIN
Credential	:
Telephone Number	:	707-441-5101

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	11/25/2025

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Directions to “COUNTY OF HUMBOLDT ” Practice Location

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