Basic Information
| Provider Information | |||||||||
| NPI: | 1760495485 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FEATHER RIVER TRIBAL HEALTH INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FEATHER RIVER TRIBAL HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2145 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959655870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305345394 | ||||||||
| FaxNumber: | 5305343820 | ||||||||
| Practice Location | |||||||||
| Address1: | 2145 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959655870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305345394 | ||||||||
| FaxNumber: | 5305343820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 09/13/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HUNZEKER | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXEC DIR | ||||||||
| AuthorizedOfficialTelephone: | 5305345394 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | N | Suppliers | Pharmacy | Clinic Pharmacy | 332800000X | N | Suppliers | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 3336C0003X | PHY47453 | CA | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2000654 | 01 | PK | OTHER | PHA457370 | 05 | CA | MEDICAID |