Organization
SOUTHERN INDIAN HEALTH COUNCIL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRANCE A KING (CFO)
(619) 445-1188
Entity
Organization
Contact information
Practice address
4058 WILLOWS RD, ALPINE, CA 91901-1668
(619) 445-1188
(619) 659-3140
Mailing address
4058 WILLOWS ROAD, ALPINE, CA 91901-1668
(619) 445-1188
(619) 659-3138
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HAP70010F
FAMILY PACT
CA
05
—
THP70010F
—
CA
01
—
W7576A
MEDICARE
CA
01
—
ZZZ58086Z
BLUE SHIELD OF CALIFORNIA
—
Enumeration date
06/28/2005
Last updated
11/12/2024
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