1336129295 NPI number — UPPER SKAGIT INDIAN TRIBE

Table of content: (NPI 1336129295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336129295 NPI number — UPPER SKAGIT INDIAN TRIBE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPPER SKAGIT INDIAN TRIBE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UPPER SKAGIT TRIBAL CLINIC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336129295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25944 COMMUNITY PLAZA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEDRO WOOLLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98284-9721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-854-7070
Provider Business Mailing Address Fax Number:
360-854-7060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25959 COMMUNITY PLAZA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEDRO WOOLLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98284-9721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-854-7070
Provider Business Practice Location Address Fax Number:
360-854-7060
Provider Enumeration Date:
01/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
TRIBAL VICE-CHAIRMAN
Authorized Official Telephone Number:
360-854-7039

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CP00001654 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: ;H00008445 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: RC00047287 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: DI00001414 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: LP00022558 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: MD00012663 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: MD00012663 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: AP30006120 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1981323 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8024291 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9645573 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7084338 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1008805 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8466286 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1995281 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7203805 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".