Provider Demographics
NPI:1508005166
Name:TULE RIVER INDIAN HEALTH CENTER, INC
Entity Type:Organization
Organization Name:TULE RIVER INDIAN HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-784-2316
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258-0768
Mailing Address - Country:US
Mailing Address - Phone:559-782-5900
Mailing Address - Fax:559-791-2533
Practice Address - Street 1:229 W CHERRY AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3401
Practice Address - Country:US
Practice Address - Phone:559-782-5900
Practice Address - Fax:559-791-2533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TULE RIVER INDIAN HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty