1306904222 NPI number — K'IMAW MEDICAL CENTER

Table of content: (NPI 1306904222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306904222 NPI number — K'IMAW MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K'IMAW MEDICAL CENTER
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:
HOOPA HEALTH ASSOCIATION
Provider Other Organization Name Type Code:
4
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:
1306904222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 AIRPORT ROAD
Provider Second Line Business Mailing Address:
PO BOX 1288
Provider Business Mailing Address City Name:
HOOPA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95546-1288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-625-4261
Provider Business Mailing Address Fax Number:
530-625-9308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95546-9615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-625-4261
Provider Business Practice Location Address Fax Number:
530-625-9308
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHASE
Authorized Official First Name:
EMMETT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
530-625-4261

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  EXEMPT INDIAN TRIBE , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: EAP11573F . This is a "EAPC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHE43666 . This is a "PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: THP11573F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05D0699458 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHE436660 . This is a "PHARMACY MEDICAID NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 005540 . This is a "BC COUNTY MEDICAID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0533922 . This is a "PHARMACY NABP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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