Provider Demographics
NPI:1851513469
Name:WESTERN SIERRA MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:WESTERN SIERRA MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:NP, EJD
Authorized Official - Phone:530-289-3298
Mailing Address - Street 1:209 NEVADA STREET
Mailing Address - Street 2:P.O. BOX 286
Mailing Address - City:DOWNIEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95936-0286
Mailing Address - Country:US
Mailing Address - Phone:530-289-3298
Mailing Address - Fax:530-289-3159
Practice Address - Street 1:209 NEVADA STREET
Practice Address - Street 2:
Practice Address - City:DOWNIEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95936-0286
Practice Address - Country:US
Practice Address - Phone:530-289-3298
Practice Address - Fax:530-289-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC03800FMedicaid
CAG43289Medicare UPIN
CAZZZ74468ZMedicare ID - Type UnspecifiedNHIC NUMBER
CA051895Medicare ID - Type UnspecifiedUGS NUMBER