Healthcare Provider Details

I. General information

NPI: 1134181555
Provider Name (Legal Business Name): JAMESTOWN S'KLALLAM TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N 5TH AVE
SEQUIM WA
98382-3045
US

IV. Provider business mailing address

808 N 5TH AVE
SEQUIM WA
98382-3045
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-5900
  • Fax: 360-582-4800
Mailing address:
  • Phone: 360-683-5900
  • Fax: 360-582-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM RON ALLEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 360-683-1109