NPIMap

Organization Active NPI

Southern Trinity Health Inc

  • Federally Qualified Health Center (FQHC)
  • Mad River, CA
National Provider Identifier
1053595744
Registry record updated Apr 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHERN TRINITY HEALTH INC
Practice address
153-A Van Duzen Rd
Mad River, CA 95552
Phone
(707) 574-6616
Fax
(707) 574-6523
NPI assigned
Dec 18, 2007
Last updated
Apr 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Graylan Lupton
Title
Chief Executive Officer
Phone
(707) 574-6616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

153-A Van Duzen Rd
Mad River, CA 95552

Mailing address

PO Box 7
Scotia, CA 95565-0007
Phone (707) 764-5617

Other identifiers 1

IdentifierTypeStateIssuer
BCP70040FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Southern Trinity Health Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650499200000",
    "number": "1053595744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7",
            "city": "SCOTIA",
            "state": "CA",
            "postal_code": "955650007",
            "telephone_number": "707-764-5617",
            "fax_number": "707-783-3511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153-A VAN DUZEN RD",
            "city": "MAD RIVER",
            "state": "CA",
            "postal_code": "95552",
            "telephone_number": "707-574-6616",
            "fax_number": "707-574-6523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN TRINITY HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A",
        "authorized_official_last_name": "LUPTON",
        "authorized_official_first_name": "GRAYLAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-574-6616"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BCP70040F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mad River, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.