Organization
FORT BIDWELL INDIAN COMMUNITY
Active
Other names
Warner Mountain Indian Health Project
Organization subpart
No
Provider details
NPI number
Authorized official
CANDICE DAWN RUSSELL FNP (CLINIC MANAGER)
(530) 279-6194
Entity
Organization
Contact information
Practice address
132 MEE THEE UH ROAD, FORT BIDWELL, CA 96112
(530) 279-6194
(530) 279-6288
Mailing address
PO BOX 247, FORT BIDWELL, CA 96112-0247
(530) 279-6194
(530) 279-6288
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
O5D0692143
CLIA
CA
05
—
THP70973F
—
CA
Enumeration date
04/17/2007
Last updated
07/02/2008
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