Mt Shasta Medi-Cal Clinic, Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

230000075 Issued in CA

Legal business name

MT SHASTA MEDI-CAL CLINIC, INC

Doing business as

Alpine Healthcare

Practice address

912 Pine St
Mount Shasta, CA 96067-2143

Phone

(530) 926-5105

Fax

(530) 926-1359

NPI assigned

Jun 10, 2006

Last updated

Aug 4, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Chris Bayless, CMPE

Title

Executive Director

Phone

(530) 926-5105

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Alpine Healthcare Doing business as

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249344000000",
    "number": "1679514483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 PINE ST",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960672143",
            "telephone_number": "530-926-5105",
            "fax_number": "530-926-1359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 PINE ST",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960672143",
            "telephone_number": "530-926-5105",
            "fax_number": "530-926-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT SHASTA MEDI-CAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2009-08-04",
        "status": "A",
        "authorized_official_last_name": "BAYLESS",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "530-926-5105",
        "authorized_official_credential": "CMPE"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "230000075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAP",
            "identifier": "EAP53856F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53856F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alpine Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mountain Valleys Health Centers (Mount Shasta Alternative Health Center)
• Mountain Valleys Health Centers (Mount Shasta Health Center)
• Mt Shasta Cardiology, Inc
• Mt Shasta Hospitalist Services Inc
• Mt Shasta Hospitalist Services Inc
• Mt. Shasta Ambulance Service Inc
• Mt. Shasta Physical Therapy, Inc.
• Diana L Muncy, LMFT
• Caleb Andrew Newton, DO
• Nicholas Patrick Brown, DO (MBS Integrative Psychiatry)

• Rural Health Clinic/Center in Mount Shasta, CA
• Providers in Mount Shasta, CA by specialty
• Rural Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2009; 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.