| Siskiyou Hospital Inc | |
| 
					8 Commercial Street Etna CA 96027  | |
| (530) 467-5393 | |
| (530) 467-5355 | 
| Full Name | Siskiyou Hospital Inc | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 8 Commercial Street, Etna, California | 
| Authorized Official Name and Position | Jonathon C Andrus (CEO) | 
| Authorized Official Contact | 5308424121 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Siskiyou Hospital Inc 444 Bruce Street Yreka CA 96097-3450 Ph: (530) 841-6256  | Siskiyou Hospital Inc 8 Commercial Street Etna CA 96027 Ph: (530) 467-5393  | 
| NPI Number | 1336330646 | 
|---|---|
| Provider Enumeration Date | 08/05/2007 | 
| Last Update Date | 12/26/2019 | 
| Medicare PECOS PAC ID | 1254223134 | 
|---|---|
| Medicare Enrollment ID | O20191120000955 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1336330646 | NPI | - | NPPES | 
| RHM18517F | Medicaid | CA | |
| BCP18517F | Medicaid | CA | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 230000035 (California) | Secondary | 
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |