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General NPI Number Information
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NPI Number | 1306904222
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Entity Type | Organization
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Legal Business Name | K'IMA:W MEDICAL CENTER
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 535 AIRPORT RD
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City | HOOPA
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State | CA
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Zip | 95546-9615
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Country | US
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Telephone | 530-625-4261
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Fax | 530-625-9308
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Provider Business Mailing Address
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Address Line | 535 AIRPORT ROAD PO BOX 1288
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City | HOOPA
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State | CA
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Zip | 95546-1288
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Country | US
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Telephone | 530-625-4261
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Fax | 530-625-9308
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Authorized Official
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Title or Position | PROJECT MANAGER
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Name | HARLEY SMITH
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Credential |
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Telephone | 530-625-4261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | EXEMPT INDIAN TRIBE
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License Number State | CA
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