Provider Demographics
NPI:1487764064
Name:LAST FRONTIER HEALTHCARE DISTRICT
Entity type:Organization
Organization Name:LAST FRONTIER HEALTHCARE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-708-8801
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-0190
Mailing Address - Country:US
Mailing Address - Phone:530-708-8801
Mailing Address - Fax:530-233-6609
Practice Address - Street 1:1111 N NAGLE ST
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-3840
Practice Address - Country:US
Practice Address - Phone:530-708-8801
Practice Address - Fax:530-233-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM13988FMedicaid
CAZZZ13295ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ93343ZMedicare PIN
CAZZZ13295ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ93342ZMedicare PIN