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NPI Code Detail

MEDICARE: COWLITZ INDIAN TRIBE

MEDICARE: COWLITZ INDIAN TRIBE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0100XHealth Service Clinic/Center
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
42083P0901XPublic Health & General Preventive Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619194123
Entity Type Code : Organization
Provider Name (Legal Business Name) : COWLITZ INDIAN TRIBE
Provider Business Mailing Address
First Line : PO BOX 2429
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-8486
Country : US
Telephone Number : 360-575-8275
Fax Number : 360-575-1950
Provider Business Practice Location Address
First Line : 900 FIR ST
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2544
Country : US
Telephone Number : 360-353-9422
Fax Number :
Authorized Official
Title or Position : BILLING SUPERVISOR
Name : SHAVON KELLER
Credential :
Telephone Number : 360-353-9431
Provider Enumeration Date : 04/19/2007
Last Update Date : 10/31/2024

Similar Medicare Providers

1285133876 — MRS. ANGELA LYNN MITCHELL LSWAIC, SUDP
Practice Location Address:
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Practice Phone: 360-575-3316
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1720086424 — NATALIE EAST P.T.
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1699773390 — SUZANNE GERHART P.T.
Practice Location Address:
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LONGVIEW, WA
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Practice Fax: 360-578-6251
1306844063 — BRUCE E PETERSON P.T.
Practice Location Address:
625 9TH AVENUE , SUITE 220
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1881692358 — DAVID E KNOEPPEL P.T.
Practice Location Address:
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1700837655 — MR. GEORGE PALMER P.T
Practice Location Address:
625 9TH AVENUE , SUITE 220
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98632-2544
Practice Phone: 360-578-1188
Practice Fax: 360-578-6251

Directions to “COWLITZ INDIAN TRIBE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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