1285895284 NPI number — UPPER SKAGIT INDIAN TRIBE

Table of content: (NPI 1285895284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285895284 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 CD 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:
1285895284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2023
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:
06/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR OF HEALTH & SOCIAL SERVICE
Authorized Official Telephone Number:
360-854-7065

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: "Y" .

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

  • Identifier: 1995281 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: UP5781 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".