MCCLOUD HEALTHCARE CLINIC, INC.; NPI #1376893420

Contact Information

MCCLOUD HEALTHCARE CLINIC, INC.

4309 STAGECOACH ROAD
DUNSMUIR, CA 96025

Phone: 530-235-4138
Fax: 530-378-2453
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Federally Qualified Health Center (FQHC)	261QF0400X	B4[14]	Federally Qualified Health Center
Rural Health	261QR1300X	B4[14]	Rural Health Clinic

Indicates primary specialty

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NPI Profile & details for MCCLOUD HEALTHCARE CLINIC, INC.

NPI Number 1376893420

LBN Legal business name MCCLOUD HEALTHCARE CLINIC, INC.

Authorized official CALEB OTT - (CEO)

Entity Organization

Organization subpart ¹ No

Enumeration date 09/17/2012

Last updated 11/01/2024 - More than a year ago

Identifiers

CA	License #	550001195
CA	License #	G32096
CA	Medicaid	00G320960

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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