Provider Demographics
NPI:1689114043
Name:HILL COUNTRY COMMUNITY CLINIC
Entity Type:Organization
Organization Name:HILL COUNTRY COMMUNITY CLINIC
Other - Org Name:HILL COUNTRY CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-945-3642
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:ROUND MOUNTAIN
Mailing Address - State:CA
Mailing Address - Zip Code:96084-0228
Mailing Address - Country:US
Mailing Address - Phone:530-337-5750
Mailing Address - Fax:530-337-5754
Practice Address - Street 1:1401 GOLD ST STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1937
Practice Address - Country:US
Practice Address - Phone:530-337-5750
Practice Address - Fax:530-337-5754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILL COUNTRY COMMUNITY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-06
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000078261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)