Healthcare Provider Details

I. General information

NPI: 1306506415
Provider Name (Legal Business Name): JAMESTOWN S'KLALLAM TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 S 9TH AVE
SEQUIM WA
98382-3626
US

IV. Provider business mailing address

526 S 9TH AVE
SEQUIM WA
98382-3626
US

V. Phone/Fax

Practice location:
  • Phone: 360-681-7755
  • Fax: 360-681-5999
Mailing address:
  • Phone: 360-681-7755
  • Fax: 360-681-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CINDY L. LOWE
Title or Position: HEALTH ADMINISTRATOR
Credential:
Phone: 360-681-4656