Healthcare Provider Details

I. General information

NPI: 1821440371
Provider Name (Legal Business Name): UNITED INDIAN HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N INDIAN RD
SMITH RIVER CA
95567-9509
US

IV. Provider business mailing address

1600 WEEOT WAY
ARCATA CA
95521-4734
US

V. Phone/Fax

Practice location:
  • Phone: 707-487-0215
  • Fax: 707-487-3003
Mailing address:
  • Phone: 707-825-5000
  • Fax: 707-825-6747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberEXEMPT
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CECIL PAUL WILSON
Title or Position: CFO
Credential:
Phone: 707-825-4065