NPIMap

Organization Active NPI

Colusa Indian Health Clinic

  • Family Nurse Practitioner
  • Colusa, CA
National Provider Identifier
1144582925
Registry record updated Jun 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
021859 Issued in CA
Legal business name
COLUSA INDIAN HEALTH CLINIC
Practice address
3710 Highway 45
Colusa, CA 95932-4026
Phone
(530) 458-5501
Fax
(530) 458-8660
NPI assigned
Jun 8, 2012
Last updated
Jun 8, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
COLUSA INDIAN COMMUNITY COUNCILAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 2012

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

Authorized official

Name
Mark Sprague
Title
Director of Clinic Operations
Phone
(530) 458-5501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 021859 CA Primary

Addresses

Primary practice location

3710 Highway 45
Colusa, CA 95932-4026

Mailing address

3710 Highway 45
Colusa, CA 95932-4026
Phone (530) 458-5501

National Provider Directory

National Provider Directory
Tax ID family
Colusa Indian Health CL5 organizations share this tax ID, including this one
Part of
Colusa Indian Health CL

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1339113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1144582925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3710 HIGHWAY 45",
            "city": "COLUSA",
            "state": "CA",
            "postal_code": "959324026",
            "telephone_number": "530-458-5501",
            "fax_number": "530-458-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3710 HIGHWAY 45",
            "city": "COLUSA",
            "state": "CA",
            "postal_code": "959324026",
            "telephone_number": "530-458-5501",
            "fax_number": "530-458-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUSA INDIAN HEALTH CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUSA INDIAN COMMUNITY COUNCIL",
        "enumeration_date": "2012-06-08",
        "last_updated": "2012-06-08",
        "status": "A",
        "authorized_official_last_name": "SPRAGUE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DIRECTOR OF CLINIC OPERATIONS",
        "authorized_official_telephone_number": "530-458-5501"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "021859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colusa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2012; 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.