MEDICARE: BURNS PAIUTE 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
1	261QH0100X	Health Service Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1710983903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURNS PAIUTE TRIBE

Provider Business Mailing Address
First Line	:	100 PASIGO ST
Second Line	:
City	:	BURNS
State	:	OR
Zip	:	97720-2442
Country	:	US
Telephone Number	:	541-573-7312
Fax Number	:	541-573-1298

Provider Business Practice Location Address
First Line	:	100 PASIGO ST
Second Line	:
City	:	BURNS
State	:	OR
Zip	:	97720-2442
Country	:	US
Telephone Number	:	541-573-7312
Fax Number	:	541-573-1298

Authorized Official
Title or Position	:	HEALTH DIRECTOR
Name	:	MS. TWILA M TEEMAN
Credential	:	RN
Telephone Number	:	541-573-7312

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/10/2008

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Directions to “BURNS PAIUTE TRIBE ” Practice Location

Language	Start Address	Practice Location

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