Provider Demographics
NPI:1689751687
Name:COUNTY OF HUMBOLDT
Entity Type:Organization
Organization Name:COUNTY OF HUMBOLDT
Other - Org Name:DEPT OF HEALTH & HUMAN SERVICES PUBLIC HEALTH BRANCH LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:PUBLIC HEALTH BRANCH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-268-2121
Mailing Address - Street 1:529 I STREET
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1116
Mailing Address - Country:US
Mailing Address - Phone:707-445-6200
Mailing Address - Fax:707-445-6097
Practice Address - Street 1:529 I STREET
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1116
Practice Address - Country:US
Practice Address - Phone:707-445-6200
Practice Address - Fax:707-445-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0666113291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB58595FMedicaid
CAZZZ17292ZMedicare PIN