NPIMap

Organization Active NPI

Squaxin Island Medicaid Encounter

  • Clinic/Center
  • Shelton, WA
National Provider Identifier
1114135779
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SQUAXIN ISLAND MEDICAID ENCOUNTER
Practice address
90 SE Klah Che Min Dr
Shelton, WA 98584-9216
Phone
(360) 427-9006
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Whitney Jones
Title
Director
Phone
(360) 427-9006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X WA Primary

Addresses

Primary practice location

90 SE Klah Che Min Dr
Shelton, WA 98584-9216

Mailing address

90 SE Klah Che Min Dr
Shelton, WA 98584-9216
Phone (360) 427-9006

Other identifiers 1

IdentifierTypeStateIssuer
7003767MedicaidWA

Other names 1

  • Squaxin Island Tribe Other name

National Provider Directory

National Provider Directory
Tax ID family
Squaxin Island Tribe11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114135779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 SE KLAH CHE MIN DR",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985849216",
            "telephone_number": "360-427-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 SE KLAH CHE MIN DR",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985849216",
            "telephone_number": "360-427-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUAXIN ISLAND MEDICAID ENCOUNTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "WHITNEY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "360-427-9006"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7003767",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Squaxin Island Tribe",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shelton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.