1023033511 NPI number — SENECA NATION OF INDIANS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023033511 NPI number — SENECA NATION OF INDIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENECA NATION OF INDIANS
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:
Provider Other Organization Name Type Code:
6
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:
1023033511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 480
Provider Second Line Business Mailing Address:
BUSINESS OFFICE
Provider Business Mailing Address City Name:
SALAMANCA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14779-0480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-945-5894
Provider Business Mailing Address Fax Number:
716-945-5652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
987 R C HOAG DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALAMANCA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14779-1365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-945-5894
Provider Business Practice Location Address Fax Number:
716-242-6345
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAYBEE
Authorized Official First Name:
SHAELA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
716-532-5582

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  EXEMPT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01658520 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03108298 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01649476 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06177279 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03090966 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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