NPIMap

Organization Active NPI

Cowlitz Indian Tribe

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Vancouver, WA
National Provider Identifier
1164649679
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
COWLITZ INDIAN TRIBE
Practice address
7700 NE 26TH Ave
Vancouver, WA 98665-0672
Phone
(360) 397-8228
Fax
(360) 575-1950
NPI assigned
Apr 19, 2007
Last updated
Jul 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COWLITZ INDIAN TRIBEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Authorized official

Name
Shavon Keller
Title
Billing Supervisor
Phone
(360) 353-9431

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary
General Practice Physician 208D00000X NU

Addresses

Primary practice location

7700 NE 26TH Ave
Vancouver, WA 98665-0672

Mailing address

P.O. Box 2429
Longview, WA 98632
Phone (360) 397-8228

Other practice location 1

900 Fir St
Longview, WA 98632-2544
Phone (360) 575-3316

Other names 1

  • Cowlitz Tribal Treatment Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050526000589 TX Part B Supplier - Clinic/Group Practice 8820030133 Receives reassigned benefits from 43 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Longview, WA; Ridgefield, WA; Toledo, WA; Tukwila, WA; Vancouver, WA; Dupont, WA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Cowlitz Indian Tribe

Locations

900 Fir St
Longview, WA 98632
Phone (360) 353-9422

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1164649679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2429",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "98632",
            "telephone_number": "360-397-8228",
            "fax_number": "360-575-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 NE 26TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986650672",
            "telephone_number": "360-397-8228",
            "fax_number": "360-575-1950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Fir St",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986322544",
            "country_code": "US",
            "telephone_number": "360-575-3316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COWLITZ INDIAN TRIBE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COWLITZ INDIAN TRIBE",
        "enumeration_date": "2007-04-19",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "SHAVON",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "360-353-9431"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cowlitz Tribal Treatment",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.