Provider Demographics
NPI:1093720609
Name:TOIYABE INDIAN HEALTH PROJECT, INC
Entity type:Organization
Organization Name:TOIYABE INDIAN HEALTH PROJECT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM-CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LENT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:760-873-8464
Mailing Address - Street 1:250 N SEE VEE LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-8130
Mailing Address - Country:US
Mailing Address - Phone:760-873-4721
Mailing Address - Fax:760-873-6127
Practice Address - Street 1:250 N SEE VEE LN
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-8130
Practice Address - Country:US
Practice Address - Phone:760-873-4721
Practice Address - Fax:760-873-6127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332800000X, 3336C0002X
CA333600000X, 3336C0002X, 333600000X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0577342OtherNCPDP PROVIDER IDENTIFIER
CA55424OtherBOARD OF PHARMACY LICENSE