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NPI Code Detail

MEDICARE: NISQUALLY INDIAN TRIBE

MEDICARE: NISQUALLY 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
2251K00000XPublic Health or Welfare Agency

General Provider Information

NPI Number : 1730075581
Entity Type Code : Organization
Provider Name (Legal Business Name) : NISQUALLY INDIAN TRIBE
Provider Business Mailing Address
First Line : 4820 SHE NAH NUM DR SE
Second Line :
City : OLYMPIA
State : WA
Zip : 98513-9105
Country : US
Telephone Number : 360-459-9603
Fax Number :
Provider Business Practice Location Address
First Line : 11702 YELM HWY SE
Second Line :
City : OLYMPIA
State : WA
Zip : 98513-9109
Country : US
Telephone Number : 360-459-9603
Fax Number :
Authorized Official
Title or Position : LIEUTENANT
Name : JEFF SMITH
Credential :
Telephone Number : 360-459-9603
Provider Enumeration Date : 06/17/2025
Last Update Date : 06/17/2025

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Directions to “NISQUALLY INDIAN TRIBE ” Practice Location

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