Provider Demographics
NPI:1972586972
Name:TULE RIVER INDIAN HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:TULE RIVER INDIAN HEALTH CENTER, INC.
Other - Org Name:TULE RIVER HEALTH CENTER, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:STAFF ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:559-791-2549
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258-0768
Mailing Address - Country:US
Mailing Address - Phone:559-784-2316
Mailing Address - Fax:559-791-2533
Practice Address - Street 1:380 N RESERVATION RD
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-9673
Practice Address - Country:US
Practice Address - Phone:559-784-2316
Practice Address - Fax:559-791-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051092OtherMEDICARE FQHC