Provider Demographics
NPI:1760248967
Name:MATHIAS EL TRIBE MEDICAL CENTER
Entity Type:Organization
Organization Name:MATHIAS EL TRIBE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED TRIBAL HEALER (CTH)
Authorized Official - Prefix:
Authorized Official - First Name:CHIEF
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIAS EL
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:818-477-7244
Mailing Address - Street 1:4305 SUN DEVILS AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-5441
Mailing Address - Country:US
Mailing Address - Phone:818-477-7244
Mailing Address - Fax:
Practice Address - Street 1:4305 SUN DEVILS AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-5441
Practice Address - Country:US
Practice Address - Phone:818-477-7244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATHIAS EL TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy