1467590547 NPI number — YAKAMA INDIAN HEALTH SERVICE

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 1467590547 NPI number — YAKAMA INDIAN HEALTH SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAKAMA INDIAN HEALTH SERVICE
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:
DHHS IHS YAKAMA SERVICE UNIT
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:
1467590547
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:
401 BUSTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPPENISH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98948-9792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-865-2102
Provider Business Mailing Address Fax Number:
509-865-4986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 BUSTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPPENISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98948-9792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-865-2102
Provider Business Practice Location Address Fax Number:
509-865-4986
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALVER
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
509-865-2102

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21940 . This is a "LABOR & INDUSTRY MED #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 51239 . This is a "LABOR & INDUSTRY RX #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4926311 . This is a "NATL ASSN BD PHARM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7100506 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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