Provider Demographics
NPI:1063589174
Name:SOUTHERN INYO HEALTHCARE DISTRICT
Entity type:Organization
Organization Name:SOUTHERN INYO HEALTHCARE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-876-5501
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:LONE PINE
Mailing Address - State:CA
Mailing Address - Zip Code:93545
Mailing Address - Country:US
Mailing Address - Phone:760-876-1146
Mailing Address - Fax:760-876-4046
Practice Address - Street 1:510 E. LOCUST
Practice Address - Street 2:
Practice Address - City:LONE PINE
Practice Address - State:CA
Practice Address - Zip Code:93545
Practice Address - Country:US
Practice Address - Phone:760-876-1146
Practice Address - Fax:760-876-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000205261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-8511OtherMEDICARE ID TYPE UNSPECIFIED