Organization Name: | SUSANVILLE INDIAN RANCHERIA |
NPI Number: | 1053484998 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STACY DIXON (TRIBAL CHAIRMAN) |
Mailing Address: | 795 Joaquin St Susanville |
State: | CA US |
Postal Code: | 961303628 |
Phone Number: | 5302578581 |
Fax Number: | 5302511846 |
NPI Enumeration Date: | 11/16/2006 |
NPI Last Update Date: | 07/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332800000X |
License Number: | PHE47046 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
Taxonomy Specialization: | |
Taxonomy Definition: | An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |