1124286885 NPI number — TUOLUMNE ME-WUK INDIAN HEALTH CENTER, INC.

Table of content: (NPI 1124286885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124286885 NPI number — TUOLUMNE ME-WUK INDIAN HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUOLUMNE ME-WUK INDIAN HEALTH CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TUOLUMNE ME-WUK HEALTH AND WELLNESS CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124286885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18880 CHERRY VALLEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUOLUMNE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95379-9506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-928-5400
Provider Business Mailing Address Fax Number:
209-928-5414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19969 GREENLEY RD
Provider Second Line Business Practice Location Address:
SUITE B,C, & D
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370-5908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-532-0028
Provider Business Practice Location Address Fax Number:
209-532-0031
Provider Enumeration Date:
05/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PEPPET
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICE
Authorized Official Telephone Number:
209-622-0334

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  550000723 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 550000723 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1619952397 . This is a "ORGANIZATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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