MCCLOUD HEALTHCARE CLINIC, INC. (NPI# 1033675582) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033675582 |
| Entity Type | Organization |
| Organization Name | MCCLOUD HEALTHCARE CLINIC, INC. |
| Practice Address |
824 Pine St Mount Shasta CA 96067-2137 |
| Mailing Address |
Po Box 1143 Mccloud CA 96057-1143 |
| Practice Telephone | 5309264528 |
| Mailing Telephone | 5309642389 |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-02-20 |
| Authorized Official Name | JAMES PROFFITT (CEO) |
| Authorized Official Telephone | 5309642389 |
| Is Organization Subpart | Y |
| Parent Organization Name | MCCLOUD HEALTHCARE CLINIC, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Siskiyou Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003372624 | Mccloud Healthcare Clinic, Inc. | Radiologic Technologist | 828 Pine St, Mount Shasta, CA 96067-2137 | 2019-02-19 |
| 1376893420 | Mccloud Healthcare Clinic, Inc. | Clinic/Center | 4309 Stagecoach Road, Dunsmuir, CA 96025 | 2012-09-17 |
| 1164428488 | Mccloud Healthcare Clinic, Inc. | Clinic/Center | 116 W Minnesota Ave, Mccloud, CA 96057-1143 | 2005-06-22 |
| Street Address |
824 PINE ST |
| City | MOUNT SHASTA |
| State | CA |
| Zip Code | 96067-2137 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164416764 | David Glenn Holst | Family Medicine | 824 Pine St, Mount Shasta, CA 96067-2137 | 2005-09-09 |
| 1508903584 | Siskiyou Medical Group PC | Family Medicine | 824 Pine St, Mount Shasta, CA 96067-2137 | 2007-01-31 |
| 1689656449 | Jeanne Marie Yalon-owens | Nurse Practitioner | 824 Pine St, Mount Shasta, CA 96067-2137 | 2005-11-17 |
| 1861482002 | Jack Leroy Haling | Pediatrics | 824 Pine St, Mount Shasta, CA 96067-2137 | 2005-10-27 |
| 1104810712 | Leslie J Andrews | Obstetrics & Gynecology | 824 Pine St, Mount Shasta, CA 96067-2137 | 2005-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538786322 | Lynn Louise Lloyd | Acupuncturist | 522 E. Alma St, Mount Shasta, CA 96067 | 2020-06-29 |
| 1356971626 | Insight Wellness Institute | Clinic/Center | 1005 Ream Ave, Mount Shasta, CA 96067 | 2020-01-24 |
| 1720477052 | Mountain Medics Inc | Ambulance | 234 Gateway Park Drive, Mount Shasta, CA 96067 | 2015-01-09 |
| 1093120172 | Diana L Muncy | Counselor | 301 N Mount Shasta Blvd Ste 2, Mount Shasta, CA 96067 | 2014-06-26 |
| 1174851901 | Aaron Michael Stutz | Emergency Medicine | 234 Gateway Park Dr., Mount Shasta, CA 96067 | 2009-12-07 |
| 1487875415 | Blanchard Leroy Foster Jr. | Marriage & Family Therapist | 110 W. Castle Street, Suite 100, Mount Shasta, CA 96067 | 2007-05-01 |
| 1699815639 | Sally Mcfall | Marriage & Family Therapist | 1180-b Mount Shasta Blvd, Mt Shasta, CA 96067 | 2007-02-07 |
| 1174672174 | Anna Klimaszewski | Marriage & Family Therapist | 425 Oakway Rd, Mt Shasta, CA 96067 | 2007-01-09 |
| 1548355969 | John Cunningham | Marriage & Family Therapist | 705 Pine St., Mt Shasta, CA 96067 | 2006-10-03 |
| 1245330844 | Jacqueline Wilkinson Gilbert-parker | Physician Assistant | 822 Pine Street, Mount Shasta, CA 96067 | 2006-09-24 |
| Find all providers in zip 96067 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629570320 | Mountain Valleys Health Centers | Clinic/Center | 101 Old Mccloud Rd, Mount Shasta, CA 96067-2796 | 2018-03-08 |
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| Find all providers with the same taxonomy | ||||
| City | MOUNT SHASTA |
| Zip Code | 96067 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.