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General NPI Number Information
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NPI Number | 1053432195
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Entity Type | Organization
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Legal Business Name | ST REGIS MOHAWK TRIBE
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 404 STATE ROUTE 37
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City | HOGANSBURG
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State | NY
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Zip | 13655-3109
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Country | US
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Telephone | 518-358-3141
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Fax | 518-358-9175
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Provider Business Mailing Address
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Address Line | 404 STATE ROUTE 37
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City | HOGANSBURG
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State | NY
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Zip | 13655-3109
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Country | US
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Telephone | 518-358-3141
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Fax | 518-358-9175
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Authorized Official
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Title or Position | HEALTH DIRECTOR
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Name | MICHAEL COOK
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Credential |
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Telephone | 518-358-3141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number | 028067
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License Number State | NY
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