| Lassen Indian Health Center | |
|
795 Joaquin St Susanville CA 96130-3628 | |
| (530) 257-2542 | |
| (530) 251-5208 |
| Full Name | Lassen Indian Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 795 Joaquin St, Susanville, California |
| Authorized Official Name and Position | Deana Bovee (TRIBAL CHAIRMAN) |
| Authorized Official Contact | 5302576264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lassen Indian Health Center 795 Joaquin St Susanville CA 96130-3628 Ph: (530) 257-2542 | Lassen Indian Health Center 795 Joaquin St Susanville CA 96130-3628 Ph: (530) 257-2542 |
| NPI Number | 1770564049 |
|---|---|
| Provider Enumeration Date | 11/14/2005 |
| Last Update Date | 04/04/2019 |
| Medicare PECOS PAC ID | 0749253946 |
|---|---|
| Medicare Enrollment ID | O20120113000762 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770564049 | NPI | - | NPPES |
| PHA470460 | Medicaid | CA | |
| THP03876F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 230000120 (California) | Primary |
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