Healthcare Provider Details

I. General information

NPI: 1346383379
Provider Name (Legal Business Name): CONFEDERATED TRIBES OF THE CHEHALIS RESERVATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 NIEDERMAN ROAD
OAKVILLE WA
98568
US

IV. Provider business mailing address

PO BOX 570
OAKVILLE WA
98568-0570
US

V. Phone/Fax

Practice location:
  • Phone: 360-709-1660
  • Fax: 360-858-7300
Mailing address:
  • Phone: 360-709-1690
  • Fax: 360-858-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN WALKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-273-5504