NPIMap

Organization Active NPI

Riverside San Bernardino County Indian Health Inc

Doing business as Morango Indian Clinic Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Banning, CA
National Provider Identifier
1902954944
Registry record updated Mar 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
PHY32790 Issued in CA
Legal business name
RIVERSIDE SAN BERNARDINO COUNTY INDIAN HEALTH INC
Doing business as
Morango Indian Clinic Pharmacy
Practice address
11555 1/2 Potrero Rd
Banning, CA 92220-6946
Phone
(951) 849-4761
Fax
(951) 849-0681
NPI assigned
Jan 8, 2007
Last updated
Mar 29, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2017

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

Authorized official

Name
Sue Yoon, BS
Title
Director of Pharmacy
Phone
(909) 864-1097

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X PHY32790 CA Primary

Addresses

Primary practice location

11555 1/2 Potrero Rd
Banning, CA 92220-6946

Mailing address

11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone (909) 864-1097

Other identifiers 2

IdentifierTypeStateIssuer
FHC03854MedicaidCA
1998432OtherPK

Other names 1

  • MORANGO INDIAN CLINIC PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Riverside San Bernardin20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

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": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490745600000",
    "number": "1902954944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11980 MOUNT VERNON AVE",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135172",
            "telephone_number": "909-864-1097",
            "fax_number": "909-503-1969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11555 1/2 POTRERO RD",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922206946",
            "telephone_number": "951-849-4761",
            "fax_number": "951-849-0681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE SAN BERNARDINO COUNTY INDIAN HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2017-03-29",
        "status": "A",
        "authorized_official_last_name": "YOON",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "909-864-1097",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "CA",
            "license": "PHY32790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03854",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1998432",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MORANGO INDIAN CLINIC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Banning, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; 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.