Lake County Tribal Health Consortium, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC.

Practice address

359 Lakeport Blvd
Lakeport, CA 95453-5412

Phone

(707) 533-2700

Fax

(707) 263-5400

NPI assigned

Feb 3, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Ernesto Padilla

Title

Executive Director

Phone

(707) 263-0329

Specialties & licenses 1

Addresses

Other names 1

• Tribal Health Pediatrics Doing business as

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

{
    "created_epoch": "1422921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1215327804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1950",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954531950",
            "telephone_number": "707-263-8382",
            "fax_number": "707-263-0329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "359 LAKEPORT BLVD",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535412",
            "telephone_number": "707-533-2700",
            "fax_number": "707-263-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-03",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "PADILLA",
        "authorized_official_first_name": "ERNESTO",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-263-0329",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tribal Health Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lake County Office of Education
• Lake County Office of Education
• Lake County Office of Education
• Lake County Office of Education
• Lake County Tribal Health Consortium Inc.
• Lake County Tribal Health Consortium, Inc.
• Lake Dermatology Medical Assoc Inc
• Lake Family Resource Center
• Lakeport County Fire Protection District
• Lakeport Emergency Medical Corporation

• Federally Qualified Health Center (FQHC) in Lakeport, CA
• Providers in Lakeport, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.