NPIMap

Organization Active NPI

Southern Mono Healthcare District

  • Institutional Pharmacy
  • Mammoth Lakes, CA
National Provider Identifier
1114353323
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
HPE 40421 Issued in CA
Legal business name
SOUTHERN MONO HEALTHCARE DISTRICT
Practice address
85 Sierra Park Rd
Mammoth Lakes, CA 93546-2073
Phone
(760) 924-4143
Fax
(760) 924-4033
NPI assigned
Sep 19, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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

Authorized official

Name
Gary Myers
Title
Ceo
Phone
(760) 924-4010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X HPE 40421 CA Primary

Addresses

Primary practice location

85 Sierra Park Rd
Mammoth Lakes, CA 93546-2073

Mailing address

PO Box 660
Mammoth Lakes, CA 93546-0660
Phone (760) 924-4143

Other names 1

  • Mammoth Hospital Other name

National Provider Directory

National Provider Directory
Tax ID family
Mammoth Hospitalb Crai9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1379548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610496000000",
    "number": "1114353323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "935460660",
            "telephone_number": "760-924-4143",
            "fax_number": "760-924-4033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SIERRA PARK RD",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "935462073",
            "telephone_number": "760-924-4143",
            "fax_number": "760-924-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MONO HEALTHCARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-19",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-924-4010"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "CA",
            "license": "HPE 40421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mammoth Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mammoth Lakes, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; 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.