1043216021 NPI number — UNITED INDIAN HEALTH SERVICES, INC.

Table of content: (NPI 1043216021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043216021 NPI number — UNITED INDIAN HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED INDIAN HEALTH SERVICES, INC.
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:
TAA-'AT-DVN
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:
1043216021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 WEEOT WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARCATA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95521-4734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-825-5000
Provider Business Mailing Address Fax Number:
707-825-6747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1675 NORTHCREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESCENT CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95531-8928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-464-2750
Provider Business Practice Location Address Fax Number:
707-464-2668
Provider Enumeration Date:
06/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
CECIL
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
707-825-4065

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X , with the licence number: EXEMPT , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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