Healthcare Provider Details

I. General information

NPI: 1588789416
Provider Name (Legal Business Name): COLVILE NATIONS COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SHORTCUT ROAD
INCHELIUM WA
99138-0290
US

IV. Provider business mailing address

39 SHORTCUT ROAD PO BOX 290
INCHELIUM WA
99138-0290
US

V. Phone/Fax

Practice location:
  • Phone: 509-722-7006
  • Fax: 509-722-3652
Mailing address:
  • Phone: 509-722-7006
  • Fax: 509-722-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TOM SARGENT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 509-722-7637