Provider Demographics
NPI:1417032921
Name:NORTHERN INYO HEALTHCARE DISTRICT
Entity type:Organization
Organization Name:NORTHERN INYO HEALTHCARE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-873-2838
Mailing Address - Street 1:150 PIONEER LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2556
Mailing Address - Country:US
Mailing Address - Phone:760-873-5811
Mailing Address - Fax:760-872-5800
Practice Address - Street 1:153 PIONEER LN STE B
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2517
Practice Address - Country:US
Practice Address - Phone:760-873-2849
Practice Address - Fax:760-872-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000179261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08578FMedicaid
CAZZZ02705ZOtherBLUE SHIELD PROVIDER #
CABCP08578FMedicaid
NV001589200Medicaid
CA058578Medicaid
CA058578Medicaid