Siskiyou Hospital Inc

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

29114 Issued in CA

Legal business name

SISKIYOU HOSPITAL INC

Practice address

475 Bruce St
Yreka, CA 96097-3474

Phone

(530) 842-3507

Fax

(530) 841-6242

NPI assigned

Jan 6, 2016

Organization subpart

Yes

Parent organization

SISKIYOU HOSPITAL INC, DBA FAIRCHILD DENTAL CLINICAs reported in NPPES

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

Authorized official

Name

Jonathon C Andrus

Title

Ceo

Phone

(530) 842-4121

Specialties & licenses 1

Addresses

Other names 1

• Fairchild Dental Clinic Doing business as

Tax ID family

Siskiyou Hospital Inc2 organizations share this tax ID, including this one

Part of

Siskiyou Hospital Inc

Other organizations with this tax ID 1

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

• Siskiyou Hospital, Inc.

  • Critical Access Hospital
  • Yreka, CA
  • NPI 1952701369
  NPD tax ID

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

{
    "created_epoch": "1452038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452038400000",
    "number": "1124484225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 BRUCE ST",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "960973450",
            "telephone_number": "530-842-4121",
            "fax_number": "530-841-6242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 BRUCE ST",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "960973474",
            "telephone_number": "530-842-3507",
            "fax_number": "530-841-6242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SISKIYOU HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SISKIYOU HOSPITAL INC, DBA FAIRCHILD DENTAL CLINIC",
        "enumeration_date": "2016-01-06",
        "last_updated": "2016-01-06",
        "status": "A",
        "authorized_official_last_name": "ANDRUS",
        "authorized_official_first_name": "JONATHON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-842-4121"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "29114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairchild Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Siskiyou Chiropractic & Massage
• Siskiyou County Public Health Department
• Siskiyou Eye Center, Medical Group, Inc
• Siskiyou Family Healthcare, Inc.
• Siskiyou Home Health Services
• Siskiyou Hospital Inc.
• Siskiyou Hospital, Inc.
• Siskiyou Hospital, Inc.
• Siskiyou Optical
• Siskiyou Pharmacy Services Inc

• Dental Hygienist in Yreka, CA
• Providers in Yreka, CA by specialty
• Dental Hygienist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; 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.