1770531501 NPI number — TULALIP TRIBES OF WASHINGTON

Table of content: (NPI 1770531501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770531501 NPI number — TULALIP TRIBES OF WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TULALIP TRIBES OF WASHINGTON
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:
TULALIP TRIBES HEALTH 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:
1770531501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6406 MARINE DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULALIP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-651-4511
Provider Business Mailing Address Fax Number:
361-651-9451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7520 TOTEM BEACH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULALIP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-651-4511
Provider Business Practice Location Address Fax Number:
360-716-5789
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOWELL
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH SYSTEM ADMINISTRATOR
Authorized Official Telephone Number:
360-716-5688

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1018537 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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