Healthcare Provider Details

I. General information

NPI: 1043156425
Provider Name (Legal Business Name): INDIGENOUS HEALTHCARE ADVANCEMENTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 SEAGATE AVE
COOS BAY OR
97420-3055
US

IV. Provider business mailing address

675 S GREEN VALLEY PKWY # 1313
HENDERSON NV
89052-0404
US

V. Phone/Fax

Practice location:
  • Phone: 808-214-7269
  • Fax:
Mailing address:
  • Phone: 808-214-7269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN RANDOLPH REEVES III
Title or Position: PRESIDENT
Credential: MHA
Phone: 808-214-7269