LAKE COUNTY TRIBAL HEALTH SOUTHSHORE CLINIC
NPI 1063158038
Clinic/Center - Federally Qualified Health Center (FQHC) in Clearlake, CA

Q: What is Lake County Tribal Health Southshore Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Active since May 11, 2022CLIA 05D0722889 · Microscopy

14440 OLYMPIC DRIVE, CLEARLAKE, CA 95422(707) 263-8382(707) 263-5019 Get Directions Write a Review

NPPES record last updated: April 2, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 2, 2024, May 11, 2022 (2 updates tracked since 2022).

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About Lake County Tribal Health Southshore Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE COUNTY TRIBAL HEALTH SOUTHSHORE CLINIC (NPI 1063158038) is a healthcare organization registered as a federally qualified health center (fqhc) in Clearlake, California and active in the NPI registry since May 2022. The organization holds a CLIA Microscopy certificate valid through December 16, 2026 and lists Ernesto Padilla, Ceo, as its authorized official.

NPPES Registry Identity

NPI1063158038

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NameLAKE COUNTY TRIBAL HEALTH SOUTHSHORE CLINIC

Location Address14440 OLYMPIC DRIVEClearlake, CA 95422

Mailing AddressPo Box 1950Lakeport, CA 95453-1950 · (707) 263-8382

Phone(707) 263-8382

Fax(707) 263-5019

Organization SubpartYesParent: Lake County Tribal Health Consortium Inc.

Authorized OfficialErnesto PadillaCeo · (707) 263-8382

Enumeration DateMay 11, 2022

Last NPPES UpdateApril 2, 20242 updates tracked since enumeration

NPPES CertifiedApril 2, 2024

✔ NPI 1063158038 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities

Taxonomy Code261QF0400X

14440 OLYMPIC DRIVE, Clearlake, CA 95422

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D0722889

Lake County Tribal Health · Lakeport, CA

Active · expires Dec 16, 2026

CLIA Number05D0722889

Laboratory TypeTribal/Ihs Joint Venture

Certificate Effective DateDecember 17, 2024

Certificate Expiration DateDecember 16, 2026

Laboratory DirectorAndre P. Lallande

Laboratory Phone(707) 263-8382

Laboratory LocationLake County Tribal Health925 Bevins Court, Lakeport, CA 95453

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SOUTHSHORE TRIBAL HEALTH PHARMACY

Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

14440 OLYMPIC DRIVE, SUITE B
CLEARLAKE, CA 95422

Lake County (707) 263-8382

SIAMAK SAHAND DMD

Dentist

14440 OLYMPIC DRIVE
CLEARLAKE, CA 95422

Lake County (707) 263-8383

TRACY M HAZELTON PA-C

Physician Assistant (Medical)

14440 OLYMPIC DRIVE
CLEARLAKE, CA 95422

Lake County (707) 263-8383

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake County Tribal Health Southshore Clinic's NPI number?

The NPI number for Lake County Tribal Health Southshore Clinic is 1063158038. It was assigned to this organization in the NPPES registry on May 11, 2022.

Where is Lake County Tribal Health Southshore Clinic located?

Lake County Tribal Health Southshore Clinic is located at 14440 Olympic Drive, Clearlake, CA 95422. The listed phone number is (707) 263-8382.

What is Lake County Tribal Health Southshore Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Lake County Tribal Health Southshore Clinic hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 05D0722889) is associated with this NPI, valid through December 16, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lake County Tribal Health Southshore Clinic was last updated on April 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.