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PINE STREET CLINIC
NPI 1942632534
Clinic/Center - Rural Health in Mount Shasta, CA

Active since August 06, 2013CLIA 05D2069763 · Waiver
408 PINE ST, MOUNT SHASTA, CA 96067(530) 926-6111(530) 926-0517 Get Directions Write a Review

NPPES record last updated: October 31, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Pine Street Clinic NPPES

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

PINE STREET CLINIC (NPI 1942632534) is a healthcare organization registered as a rural health in Mount Shasta, California and active in the NPI registry since August 2013. The organization holds a CLIA Waiver certificate valid through June 4, 2028 and lists Kim Miranda, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1942632534
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameDIGNITY HEALTH
Location Address408 PINE STMount Shasta, CA 96067-2126
Mailing Address3400 Data Dr, 1st FloorRancho Cordova, CA 95670-7956 · (530) 225-6300 · Fax (530) 225-7278
Phone(530) 926-6111
Fax(530) 926-0517
Organization SubpartYes
Authorized OfficialKim MirandaChief Financial Officer · (530) 225-6121
Enumeration DateAugust 6, 2013
Last NPPES UpdateOctober 31, 2016
✔ NPI 1942632534 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
408 PINE ST, Mount Shasta, CA 96067
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Other Names 1

Doing Business AsPine Street Clinic

Other Identifiers 2

Medicare OSCAR/certification058674CA
Other473431860Sp Tin

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 of Waiver 05D2069763

Pine Street Clinic · Mount Shasta, CA
Active · expires Jun 4, 2028
CLIA Number05D2069763
Laboratory TypeCommunity Clinic
Certificate Effective DateJune 5, 2026
Certificate Expiration DateJune 4, 2028
Laboratory DirectorMatthew J. Kilpatrick
Laboratory Phone(530) 926-9334
Laboratory LocationPine Street Clinic408 Pine St, Mount Shasta, CA 96067
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

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

DR. JOHN MILO KATANA M.D.
Family Medicine
408 PINE ST
MOUNT SHASTA, CA 96067
Siskiyou County (530) 926-7196
DR. PHILLIP M MILLER M.D.
Family Medicine
408 PINE ST
MOUNT SHASTA, CA 96067
Siskiyou County (530) 926-7196

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 Dignity Health's NPI number?

The NPI number for Dignity Health is 1942632534. It was assigned to this organization in the NPPES registry on August 6, 2013. The provider is doing business as Pine Street Clinic.

Where is Dignity Health located?

Dignity Health is located at 408 Pine St, Mount Shasta, CA 96067. The listed phone number is (530) 926-6111.

What is Dignity Health's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Does Dignity Health hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2069763) is associated with this NPI, valid through June 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Dignity Health was last updated on October 31, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.