NPIMap

Organization Active NPI

Lower Elwha Maternal Support Services

  • Federally Qualified Health Center (FQHC)
  • Port Angeles, WA
National Provider Identifier
1205151388
Registry record updated Apr 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LOWER ELWHA MATERNAL SUPPORT SERVICES
Practice address
243511 W Highway 101
Port Angeles, WA 98363-9472
Phone
(360) 452-6252
Fax
(360) 452-6274
NPI assigned
Apr 1, 2010
Last updated
Apr 19, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
LOWER ELWHA KLALLAM TRIBEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2010

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

Authorized official

Name
Florence Patricia McEachrane-Gross, MD
Title
Medical & Health Director
Phone
(360) 452-6252

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

243511 W Highway 101
Port Angeles, WA 98363-9472

Mailing address

243511 W Highway 101
Port Angeles, WA 98363-9472
Phone (360) 452-6252

Other identifiers 1

IdentifierTypeStateIssuer
7402480MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Lower Elwah Band of Klallam8 organizations share this tax ID, including this one
Part of
Lower Elwah Band of Klallam

Other organizations with this tax ID 7

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": "1270080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271635200000",
    "number": "1205151388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243511 W HIGHWAY 101",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983639472",
            "telephone_number": "360-452-6252",
            "fax_number": "360-452-6274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243511 W HIGHWAY 101",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983639472",
            "telephone_number": "360-452-6252",
            "fax_number": "360-452-6274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOWER ELWHA MATERNAL SUPPORT SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOWER ELWHA KLALLAM TRIBE",
        "enumeration_date": "2010-04-01",
        "last_updated": "2010-04-19",
        "status": "A",
        "authorized_official_last_name": "MCEACHRANE-GROSS",
        "authorized_official_first_name": "FLORENCE",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "MEDICAL & HEALTH DIRECTOR",
        "authorized_official_telephone_number": "360-452-6252",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7402480",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2010; 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.