United Indian Health Services, Inc.
Organization Active NPI Community Health Clinic/Center · Weitchpec, CA
NPI 1265438154 · NPPES record last updated Dec 22, 2023
Key facts
- NPI
- 1265438154
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- Legal business name
- UNITED INDIAN HEALTH SERVICES, INC.
- Practice address
- 23001 Ca-96
Weitchpec, CA 95546 - Phone
- (530) 625-4300
- Fax
- (530) 625-4308
- NPI assigned
- Jun 24, 2005
- Organization subpart
- No
Authorized official
- Name
- Cecil Paul Wilson
- Title
- Cfo
- Phone
- (707) 825-4065
Owners & managing parties with NPI records 8
Owned or controlled facilities with NPI records 7
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 12
Facilities with the same owner 6
Practitioners 41
-
Tin C. Botzler, MD
-
Antoinette Patricia Martinez, M. D.
-
Hugh Kent, MD
-
Gurudarshan S Khalsa, M.D.
-
Rachael Adair, CNM, PMHNP
-
Mya Ashlyn Alves, PA-C
-
Joseph T. Breen, D.P.M
-
Margaret L. Grossman, M.D.
-
Nora A Healey, FNP
-
May Chien-Shian Hong, M.D.
-
Heather Kyte, PA-C
-
Allegra Stroup, FNP
-
Lynn Marie Szabo, PAC
-
Andrea Hillary Ward, FNP
-
Andrew M Freeman, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2168332 | United Indian Health Services | Provider-performed microscopy | Jun 25, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 051165
- Legal name
- UNITED INDIAN HEALTH SERVICES, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 7, 2009
- Last certification
- May 7, 2009
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 16, 1970 in CA
- Enrollment address
- Junc of Hwy 96 & Hwy 196
Weitchpec, CA 95546-9399
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Elizabeth Lara-O'Rourke |
Corporate Officer |
Nov 1, 2021 | |
| Operational/Managerial Control |
Nov 1, 2021 | ||
| Cecil Wilson |
Corporate Officer |
Nov 15, 2021 | |
| Operational/Managerial Control |
Nov 15, 2021 | ||
| Christopher Myers |
Corporate Officer |
Sep 20, 2021 | |
| Operational/Managerial Control |
Sep 20, 2021 | ||
| United Indian Health Services, Inc. |
Operational/Managerial Control | Jun 4, 2009 |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Potawot Health Village |
Federally qualified health center | Operational/Managerial Control | Jul 1, 2009 |
| United Indian Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control | Jun 30, 2009 |
| United Indian Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control (100%) | Dec 15, 2014 |
| United Indian Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control | Jul 1, 2009 |
| Xaa-Wan'-K'WVT Clinic |
Federally qualified health center | Operational/Managerial Control | Mar 1, 2017 |
| United Indian Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control | Oct 1, 2022 |
| United Indian Health Services, Inc. |
Federally qualified health center | Other (100%) | Aug 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040225000459 | CA | Part B Supplier - Clinic/Group Practice | 9830085075 |
Receives reassigned benefits from 66 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Eureka, CA; Smith River, CA; Klamath, CA; Hoopa, CA; Crescent City, CA; Arcata, CA |
| O20090408000471 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 9830085075 | Practice locations: Weitchpec, CA |
National Provider Directory
- Tax ID family
- United Indian HLTH SVCS Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | |||
| Community Health Clinic/Center | 261QC1500X | Yes | ||
| Dental Clinic/Center | 261QD0000X |
Addresses
Primary practice location
23001 Ca-96
Weitchpec, CA 95546
Mailing address
1600 Weeot Way
Arcata, CA 95521-4734
Phone (707) 825-5000
Other names
- Weitchpec Health Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.