NPIMap

Organization Active NPI

Snoqualmie Indian Tribe

  • Public Health & General Preventive Medicine Physician
  • Snoqualmie, WA
National Provider Identifier
1043873722
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
Legal business name
SNOQUALMIE INDIAN TRIBE
Practice address
9575 Ethan Wade Way SE
Snoqualmie, WA 98065-9577
Phone
(425) 831-5425
Fax
(425) 831-5428
NPI assigned
Apr 17, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jean Medina
Title
Compliance Manager
Phone
(425) 831-5425

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health & General Preventive Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0901X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

9575 Ethan Wade Way SE
Snoqualmie, WA 98065-9577

Mailing address

PO Box 969
Attn Compliance Manager
Snoqualmie, WA 98065-0969
Phone (425) 831-5425

Other identifiers 1

IdentifierTypeStateIssuer
2137735MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Snoqualmie Indian Tribe2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1043873722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 969",
            "address_2": "ATTN COMPLIANCE MANAGER",
            "city": "SNOQUALMIE",
            "state": "WA",
            "postal_code": "980650969",
            "telephone_number": "425-831-5425",
            "fax_number": "425-831-5428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9575 ETHAN WADE WAY SE",
            "city": "SNOQUALMIE",
            "state": "WA",
            "postal_code": "980659577",
            "telephone_number": "425-831-5425",
            "fax_number": "425-831-5428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNOQUALMIE INDIAN TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-17",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "COMPLIANCE MANAGER",
        "authorized_official_telephone_number": "425-831-5425"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2137735",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Snoqualmie, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.