Provider Demographics
NPI:1477563518
Name:NORTHEASTERN RURAL HEALTH CLINICS
Entity Type:Organization
Organization Name:NORTHEASTERN RURAL HEALTH CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-251-1428
Mailing Address - Street 1:1850 SPRING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-6100
Mailing Address - Country:US
Mailing Address - Phone:530-251-5000
Mailing Address - Fax:530-257-6015
Practice Address - Street 1:1850 SPRING RIDGE DR
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-6100
Practice Address - Country:US
Practice Address - Phone:530-251-5000
Practice Address - Fax:530-257-6015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEASTERN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-09
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ87615ZOtherBLUE SHIELD
080005169OtherRRMCR DOZIER
080042465OtherRRMCR HOLMES
080119610OtherRRMCR DAVAINIS
080061921OtherRRMCR MORGAN
CAFHC70081FMedicaid
080119610OtherRRMCR DAVAINIS