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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)
32083P0901XPublic Health & General Preventive Medicine Physician

General Provider Information

NPI Number : 1972962165
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 : 360-397-8228
Fax Number : 360-575-1950
Provider Business Practice Location Address
First Line : 7700 NE 26TH AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98665-0672
Country : US
Telephone Number : 360-397-8228
Fax Number : 360-575-1950
Authorized Official
Title or Position : BILLING SUPERVISOR
Name : SHAVON KELLER
Credential :
Telephone Number : 360-353-9431
Provider Enumeration Date : 02/16/2016
Last Update Date : 02/03/2023

Similar Medicare Providers

1063787216 — DAVID ALDEN PULLIAM LMHC
Practice Location Address:
7700 NE 26TH AVE
VANCOUVER, WA
98665-0672
Practice Phone: 360-397-8228
Practice Fax:
1164649679 — COWLITZ INDIAN TRIBE
Practice Location Address:
7700 NE 26TH AVE
VANCOUVER, WA
98665-0672
Practice Phone: 360-397-8228
Practice Fax: 360-575-1950
1114246535 — CHRISTOPHER TODD LAKE MPH,CDP
Practice Location Address:
7700 NE 26TH AVE
VANCOUVER, WA
98665-0672
Practice Phone: 360-397-8228
Practice Fax: 360-397-8259
1104261817 — KARA D FRIZZELL
Practice Location Address:
7700 NE 26TH AVE
VANCOUVER, WA
98665-0672
Practice Phone: 360-397-8228
Practice Fax:
1629462726 — ALLISON LYNN JONES MA
Practice Location Address:
7700 NE 26TH AVE
VANCOUVER, WA
98665-0672
Practice Phone: 360-397-8228
Practice Fax:
1760845853 — JENNIFER FRESH PMHNP, ARNP
Practice Location Address:
7700 NE 26TH AVE
VANCOUVER, WA
98665-0672
Practice Phone: 360-397-8228
Practice Fax: 360-353-9440

Directions to “COWLITZ INDIAN TRIBE ” Practice Location

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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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