MEDICARE: TULALIP TRIBES HEALTH CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0096092	OTHER	WA	LABOR INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043263742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TULALIP TRIBES HEALTH CLINIC

Provider Business Mailing Address
First Line	:	7520 TOTEM BEACH RD
Second Line	:
City	:	TULALIP
State	:	WA
Zip	:	98271
Country	:	US
Telephone Number	:	360-651-4511
Fax Number	:	360-651-9451

Provider Business Practice Location Address
First Line	:	7520 TOTEM BEACH RD
Second Line	:
City	:	TULALIP
State	:	WA
Zip	:	98271
Country	:	US
Telephone Number	:	360-651-4511
Fax Number	:	360-651-9451

Authorized Official
Title or Position	:	HEALTH MANAGER
Name	:	KAREN I FRYBERG
Credential	:
Telephone Number	:	360-651-4515

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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