Mountain Health & Community Services, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

090000511 Issued in CA

Legal business name

MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.

Practice address

44460 Old Hwy 80
Jacumba, CA 91934

Phone

(619) 766-4071

Fax

(619) 766-4128

NPI assigned

Dec 1, 2006

Organization subpart

No

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

Authorized official

Name

Judith Shaplin

Title

Ceo

Phone

(619) 445-6200

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• High Desert Family Medicine Doing business as

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317772800000",
    "number": "1740358258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31115 HIGHWAY 94",
            "city": "CAMPO",
            "state": "CA",
            "postal_code": "919063133",
            "telephone_number": "619-478-5254",
            "fax_number": "619-478-9164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44460 OLD HWY 80",
            "city": "JACUMBA",
            "state": "CA",
            "postal_code": "91934",
            "telephone_number": "619-766-4071",
            "fax_number": "619-766-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2011-10-05",
        "status": "A",
        "authorized_official_last_name": "SHAPLIN",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "619-445-6200"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "090000511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC53850F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PROGRAM",
            "identifier": "HAP53850F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PROGRAM",
            "identifier": "BCP53850F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "High Desert Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carri Lee Escalante, NURSE ASSIATANT

• All providers in Jacumba, CA
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; 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.