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General NPI Number Information
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NPI Number | 1770328718
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Entity Type | Organization
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Legal Business Name | EASTERN SHOSHONE TRIBE
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Dates
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Enumeration Date | 07/01/2024
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 29 BLACK COAL DR
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City | FORT WASHAKIE
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State | WY
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Zip | 82514
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Country | US
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Telephone | 307-332-7300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 128
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City | FORT WASHAKIE
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State | WY
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Zip | 82514-0128
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Country | US
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Telephone | 307-332-2027
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ANDREW MCALPIN
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Credential | MD
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Telephone | 307-335-5912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number |
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License Number State |
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