Organization
EASTERN PLUMAS HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JERILEE NELSON CPA (CFO)
(530) 832-6577
Entity
Organization
Contact information
Practice address
500 1ST AVE, PORTOLA, CA 96122-9406
(530) 832-6500
(530) 832-1105
Mailing address
500 1ST AVE, PORTOLA, CA 96122-9406
(530) 832-6500
(530) 832-1105
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0366490002
CA
332B00000X
Durable Medical Equipment & Medical Supplies
100604
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DME01426F
—
CA
01
—
ZZZ22148Z
BLUE SHIELD DME
CA
Enumeration date
06/24/2005
Last updated
06/11/2009
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