Provider Demographics
NPI:1831128602
Name:SOUTHERN INYO HEALTHCARE DISTRICT
Entity Type:Organization
Organization Name:SOUTHERN INYO HEALTHCARE DISTRICT
Other - Org Name:SOUTHERN INYO HEALTHCARE DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-876-5501
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:LONE PINE
Mailing Address - State:CA
Mailing Address - Zip Code:93545-1009
Mailing Address - Country:US
Mailing Address - Phone:760-876-5501
Mailing Address - Fax:760-876-4388
Practice Address - Street 1:501 E. LOCUST STREET
Practice Address - Street 2:
Practice Address - City:LONE PINE
Practice Address - State:CA
Practice Address - Zip Code:93545
Practice Address - Country:US
Practice Address - Phone:760-876-5501
Practice Address - Fax:760-876-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000205261QR1300X, 282NC0060X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT30388FMedicaid
CALTC55527FMedicaid
CAMTN01039FMedicaid
CARHM18511FMedicaid
CAZZT40388FMedicaid
CALTC55527FMedicaid
CA05-1302Medicare Oscar/Certification
CARHM18511FMedicaid
CA05-8511Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC
CAZZZ92769ZMedicare ID - Type UnspecifiedEMERGENCY ROOM PRO FEE
CAMTN01039FMedicaid