Provider Demographics
NPI:1497258610
Name:SOUTHERN MONO HEALTHCARE DISTRICT
Entity Type:Organization
Organization Name:SOUTHERN MONO HEALTHCARE DISTRICT
Other - Org Name:ORTHOPEDIC CLINIC - BISHOP
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VAN WINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-924-4012
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-0660
Mailing Address - Country:US
Mailing Address - Phone:760-934-3311
Mailing Address - Fax:
Practice Address - Street 1:168 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3415
Practice Address - Country:US
Practice Address - Phone:760-872-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN MONO HEALTHCARE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service