Healthcare Provider Details

I. General information

NPI: 1306037767
Provider Name (Legal Business Name): MAKAH TRIBAL COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 2ND AVE
NEAH BAY WA
98357
US

IV. Provider business mailing address

181 RESORT DRIVE
NEAH BAY WA
98357
US

V. Phone/Fax

Practice location:
  • Phone: 360-645-2481
  • Fax: 360-645-2690
Mailing address:
  • Phone: 360-645-3210
  • Fax: 360-645-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number05X04
License Number StateWA

VIII. Authorized Official

Name: LOIS PETERSON
Title or Position: ADMINISTRATIVE SERVICES MANAGER
Credential:
Phone: 360-645-3210