Provider Demographics
NPI:1619952397
Name:TUOLUMNE MEWUK INDIAN HEALTH CENTER, INC
Entity Type:Organization
Organization Name:TUOLUMNE MEWUK INDIAN HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-928-5453
Mailing Address - Street 1:18880 CHERRY VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-9612
Mailing Address - Country:US
Mailing Address - Phone:209-928-5450
Mailing Address - Fax:209-928-5414
Practice Address - Street 1:18880 CHERRY VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:TUOLUMNE
Practice Address - State:CA
Practice Address - Zip Code:95379-9612
Practice Address - Country:US
Practice Address - Phone:209-928-5450
Practice Address - Fax:209-928-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18496103TC1900X
CAG50654207Q00000X
CAG73139207Q00000X
CA20A7824207Q00000X
CAG32948207Q00000X
CAA53764208000000X
CAA626282084P0800X
CAPA15883363A00000X
CANP14383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F78341Medicare UPIN
OPL184961Medicare UPIN
CAG60958Medicare UPIN
P52048Medicare UPIN
H29538Medicare UPIN
A45357Medicare UPIN
A51764Medicare UPIN
CAQ42494Medicare UPIN
CAP37404Medicare UPIN