Organization
SISKIYOU HOSPITAL, INC.
Active
Other names
Fairchild Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHON C ANDRUS CEO (CHEIF EXECUTIVE OFFICER)
(530) 841-6200
Entity
Organization
Contact information
Practice address
444 BRUCE ST, YREKA, CA 96097-3450
(530) 842-4121
(530) 841-6242
Mailing address
444 BRUCE ST, YREKA, CA 96097-3450
(530) 842-4121
(530) 841-6242
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
230000035
CA
261QR1300X
Rural Health Clinic/Center
230000035
CA
275N00000X
Medicare Defined Swing Bed Hospital Unit
230000035
CA
282NC0060X
Critical Access Hospital
Primary
230000035
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058634
—
CA
05
—
HSP40217F
—
CA
05
—
ZZR00217F
—
CA
01
—
ZZZJ4702Z
BLUE SHIELD
CA
Enumeration date
11/01/2006
Last updated
12/14/2015
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