| Organization Name: | COLUSA INDIAN HEALTH CLINIC |
| NPI Number: | 1144582925 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK SPRAGUE (DIRECTOR OF CLINIC OPERATIONS) |
| Mailing Address: | 3710 Highway 45 Colusa |
| State: | CA US |
| Postal Code: | 959324026 |
| Phone Number: | 5304585501 |
| Fax Number: | 5304588660 |
| NPI Enumeration Date: | 06/08/2012 |
| NPI Last Update Date: | 06/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 021859 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |