Provider Demographics
NPI:1124286885
Name:TUOLUMNE ME-WUK INDIAN HEALTH CENTER, INC.
Entity type:Organization
Organization Name:TUOLUMNE ME-WUK INDIAN HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-622-0334
Mailing Address - Street 1:18880 CHERRY VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-9506
Mailing Address - Country:US
Mailing Address - Phone:209-928-5400
Mailing Address - Fax:209-928-5414
Practice Address - Street 1:19969 GREENLEY RD
Practice Address - Street 2:SUITE B,C, & D
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5908
Practice Address - Country:US
Practice Address - Phone:209-532-0028
Practice Address - Fax:209-532-0031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUOLUMNE ME-WUK INDIAN HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-29
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550000723OtherSTATE LICENSE NUMBER
CA1619952397OtherORGANIZATION