1386726032 NPI number — KARUK TRIBE

Table of content: (NPI 1386726032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386726032 NPI number — KARUK TRIBE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARUK 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:
KARUK ORLEANS MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
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:
1386726032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1016
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAPPY CAMP
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96039-1016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-493-1600
Provider Business Mailing Address Fax Number:
530-493-1648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 ASIP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLEANS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95556-0249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-627-3452
Provider Business Practice Location Address Fax Number:
503-627-3445
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ATTEBERY
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
Authorized Official Title or Position:
TRIBAL CHAIRMAN
Authorized Official Telephone Number:
530-493-1600

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1386726032 . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1386726032 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ09862Z . This is a "BLUE SHIELD OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com