SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT — NPI 1336367515 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in GARBERVILLE, CA)

CMS-1500 Box 24J / 33a • NPI

1336367515

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QR1300X (CMS B4[14])

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

509 ELM ST, GARBERVILLE, CA, 95542-3204

✓ 9-Digit EDI 837 ZIP+4 (95542-3204)

Practice Phone & Referral Fax

(707) 923-3921

Fax: (707) 923-1456

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1336367515 (SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1336367515` (NPI-2 Organization / Facility)
Provider / Legal Name	SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QR1300X` (Clinic/Center, Rural Health)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	509 ELM ST, GARBERVILLE, CA, 95542-3204
Practice Telephone / Fax	Tel: (707) 923-3921 \| Fax: (707) 923-1456
Administrative Mailing Address	733 CEDAR ST, GARBERVILLE, CA, 95542-3201
Enumeration & Last Sync	Enumerated: 2007-04-23 \| CMS Record Updated: 2021-07-01
Authorized Official	SUSAN GARDNER (Med Staff Coordinator)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

509 ELM ST, GARBERVILLE, CA, 95542-3204

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Plain-English Taxonomy & CMS Crosswalk (261QR1300X)

What Does Taxonomy Code 261QR1300X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QR1300X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: CMS Code B4[14] (Rural Health Clinic)
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`261QR1300X` — Clinic/Center, Rural Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: CA \| License: `110000052` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT (NPI #1336367515)