Provider Demographics
NPI:1295491736
Name:SOUTHERN INDIAN HEALTH COUNCIL
Entity type:Organization
Organization Name:SOUTHERN INDIAN HEALTH COUNCIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LEAD BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-445-1188
Mailing Address - Street 1:5001 WILLOWS RD STE J111
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-1684
Mailing Address - Country:US
Mailing Address - Phone:619-445-1188
Mailing Address - Fax:
Practice Address - Street 1:5001 WILLOWS RD STE J111
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1684
Practice Address - Country:US
Practice Address - Phone:619-445-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN INDIAN HEALTH COUNCIL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-09
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7576AOtherMEDICARE
CATHP70010FMedicaid