Organization · Type 2 NPI
Lake County Tribal Health Southshore Clinic
Federally Qualified Health Center (FQHC) · Clearlake, CA
NPI number
1063158038
Active
Practice location
14440 Olympic Drive
Clearlake, CA 95422
Fax (707) 263-5019
Mailing address
PO Box 1950
Lakeport, CA 95453-1950
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Federally Qualified Health Center (FQHC) Primary | 261QF0400X | None listed |
Federally Qualified Health Center (FQHC): Definition to come...
3 other providers at this address
Other federally qualified health center (fqhc) providers in Clearlake
About NPI 1063158038
Lake County Tribal Health Southshore Clinic's National Provider Identifier is 1063158038, issued on May 11, 2022. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Clearlake, CA. The record was last updated on Apr 2, 2024.