SOUTHERN INDIAN HEALTH COUNCIL INC (NPI# 1417026758) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417026758 |
| Entity Type | Organization |
| Organization Name | SOUTHERN INDIAN HEALTH COUNCIL INC |
| Other Organization Name | SOUTHERN INDIAN HEALTH COUNCIL |
| Practice Address |
36350 Church Rd Campo CA 91906-2715 |
| Practice Telephone | 6194782225 |
| Practice Fax Number | 6194782323 |
| Mailing Telephone | 6194782225 |
| Mailing Fax Number | 6194782323 |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2017-10-04 |
| Authorized Official Name | DEAN GARCIA (PIC) |
| Authorized Official Telephone | 6194451188 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | PHE43448 | CA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | PHA434480 | 05 | |
| PK | 2113505 | 01 |
| Other Name | Type Code |
|---|---|
| SOUTHERN INDIAN HEALTH COUNCIL | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922090885 | Southern Indian Health Council Inc | Clinic/Center | 36350 Church Road, Campo, CA 91906-2715 | 2005-08-17 |
| 1346247947 | Southern Indian Health Council Inc | Clinic/Center | 4058 Willows Rd, Alpine, CA 91901-1668 | 2005-06-28 |
| 1235280223 | Southern Indian Health Council Inc | Pharmacy | 4058 Willows Rd, Alpine, CA 91901-1668 | 2007-01-16 |
| Street Address |
36350 CHURCH RD |
| City | CAMPO |
| State | CA |
| Zip Code | 91906-2715 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982957361 | Abby Jane-marie Cordova | Marriage & Family Therapist | 36350 Church Rd, Campo, CA 91906-2715 | 2012-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316424351 | Jr Ranch | Substance Abuse Rehabilitation Facility | 1765 Buckman Springs Rd, Campo, CA 91906 | 2018-07-23 |
| 1336592740 | Mountain Health & Community Services, Inc. | Clinic/Center | 1388 Buckman Springs Road, Campo, CA 91906 | 2016-07-20 |
| 1932572385 | Joshua Knutson | Marriage & Family Therapist | 976 Sheridan Rd, Campo, CA 91906 | 2015-11-06 |
| 1093937591 | San Diego Freedom Ranch, Inc. | Substance Abuse Rehabilitation Facility | 1777 Buckman Springs Rd, Campo, CA 91906 | 2007-05-03 |
| 1760603740 | Linda Rae Anderson | Acupuncturist | 33446 Hwy 94, Campo, CA 91906 | 2007-05-01 |
| 1407887227 | Jay Mark Cool | Physician Assistant | 31115 Highway 94, Campo, CA 91906 | 2006-07-06 |
| 1518577493 | Billy Don Wilson | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2020-08-05 |
| 1043820202 | Marco Martinez | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2020-08-03 |
| 1831725779 | David M Pardue | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2020-03-22 |
| 1316505100 | Michael Derek Waters | Counselor | 1777 Buckman Springs Rd, Campo, CA 91906-2022 | 2019-06-05 |
| Find all providers in zip 91906 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598108847 | Hometown Ltc Pharmacy Inc | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1450 W Mccoy Ln Ste B, Santa Maria, CA 93455-1059 | 2013-04-16 |
| 1144873811 | Hometown Ltc Pharmacy Inc | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1009 E Grand Ave, Arroyo Grande, CA 93420-2504 | 2019-07-22 |
| 1407252588 | Ihc Santa Ysabel Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 110 1/2 School House Canyon Road, Santa Ysabel, CA 92070 | 2014-11-17 |
| 1053484998 | Susanville Indian Rancheria | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 795 Joaquin St, Susanville, CA 96130-3628 | 2006-11-16 |
| 1982782256 | United Indian Health Services Inc | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1600 Weeot Way, Arcata, CA 95521-4734 | 2006-11-02 |
| 1699881540 | Tuolumne Me-wuk Indian Health Center Incorporated | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 18880 Cherry Valley Blvd, Tuolumne, CA 95379-9506 | 2006-08-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.