Healthcare Provider Details

I. General information

NPI: 1114674942
Provider Name (Legal Business Name): SUQUAMISH TRIBAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6968 NE ENETAI LN
SUQUAMISH WA
98392-9766
US

IV. Provider business mailing address

PO BOX 1228
SUQUAMISH WA
98392-1228
US

V. Phone/Fax

Practice location:
  • Phone: 360-394-1350
  • Fax: 360-598-2783
Mailing address:
  • Phone: 360-394-1423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA A JONES
Title or Position: HEALTH COMPLIANCE OFFICER
Credential:
Phone: 360-394-1423