Organization
I'SOT INC
Active
Other names
Canby Family Practice Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GRETA J ELLIOTT (ADMINISTRATOR)
(530) 233-4641
Entity
Organization
Contact information
Practice address
670 COUNTY ROAD 83, CANBY, CA 96015-9722
(530) 233-4641
(530) 233-4140
Mailing address
670 COUNTY ROAD 83, CANBY, CA 96015-9722
(530) 233-4641
(530) 233-4140
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
230000116
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RHM03888F
—
CA
01
—
ZZZ21128Z
MEDICARE PART B
CA
Enumeration date
06/20/2005
Last updated
09/17/2012
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