Provider Demographics
NPI:1659433191
Name:TOIYABE INDIAN HEALTH PROJECT, INC
Entity Type:Organization
Organization Name:TOIYABE INDIAN HEALTH PROJECT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-873-8464
Mailing Address - Street 1:250 N SEE VEE LANE
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-8130
Mailing Address - Country:US
Mailing Address - Phone:760-873-8464
Mailing Address - Fax:760-503-4174
Practice Address - Street 1:250 N SEE VEE LN
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-8130
Practice Address - Country:US
Practice Address - Phone:760-873-8464
Practice Address - Fax:760-503-4174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOIYABE INDIAN HEALTH PROJECT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QF0400X
CAEXEMPT261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP11576FMedicaid
CAFHC11576FMedicaid
CATHP11576FMedicaid
CAZZZ85276ZMedicare ID - Type UnspecifiedBISHOP CLINIC MEDICARE #
CATHP11576FMedicaid