Swinomish Indian Tribal Community
Organization Active NPI Clinic/Center · La Conner, WA
NPI 1164483285 · NPPES record last updated Oct 5, 2011
Key facts
- NPI
- 1164483285
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- SWINOMISH INDIAN TRIBAL COMMUNITY
- Practice address
- 17400 Reservation Rd
La Conner, WA 98257-8801 - Phone
- (360) 466-3167
- Fax
- (360) 466-5528
- NPI assigned
- Mar 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Rhonda Nelson, D.P.M
- Title
- Clinical Applications Coordinator
- Phone
- (360) 466-3167
Other NPIs on the same Medicare enrollment 1
Practitioners 5
-
Justin Iwasaki, MD
-
David Michael Johnson, PA-C
-
Monica Carrillo, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090819000142 | WA | Part B Supplier - Clinic/Group Practice | 3678477288 |
Receives reassigned benefits from 5 practitioners 1 other NPI on this enrollment Practice locations: La Conner, WA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
17400 Reservation Rd
La Conner, WA 98257-8801
Mailing address
PO Box 683
La Conner, WA 98257-0683
Phone (360) 466-3167
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7084320 | Medicaid | WA |
Other providers in La Conner, WA
- Sarah Blair Stensrud
- Sharon A Sullivan
- Swinomish Health Clinic
- Swinomish Health Clinic
- Swinomish Health Clinic
- Swinomish Indian Tribal Community
- Swinomish Indian Tribal Community
- Swinomish Indian Tribal Community
- Swinomish Tribal Mental Health Program
- Swinomish Upper Skagit Dental
All providers in La Conner, WA · Clinic/Center in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.