Healthcare Provider Details

I. General information

NPI: 1639210370
Provider Name (Legal Business Name): OMAK TRIBAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BENTON STREET
OMAK WA
98841-0962
US

IV. Provider business mailing address

PO BOX 71
NESPELEM WA
99155-0071
US

V. Phone/Fax

Practice location:
  • Phone: 509-634-2900
  • Fax: 509-634-2990
Mailing address:
  • Phone: 509-634-2900
  • Fax: 509-634-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: YVONNE IVERSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 509-634-2900