Healthcare Provider Details

I. General information

NPI: 1699649202
Provider Name (Legal Business Name): CONFEDERATED TRIBES OF THE COLVILLE RESERVATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BENTON ST
OMAK WA
98841-9636
US

IV. Provider business mailing address

PO BOX 150
NESPELEM WA
99155-0150
US

V. Phone/Fax

Practice location:
  • Phone: 509-634-2900
  • Fax: 509-634-2963
Mailing address:
  • Phone: 509-634-2783
  • Fax: 509-634-2963

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: AMY CHURCH
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 509-634-2783