NPIMap

Organization Active NPI

Shoalwater Bay Indian Tribe

Doing business as Shoalwater Bay Tribal Clinic

  • Federally Qualified Health Center (FQHC)
  • Tokeland, WA
National Provider Identifier
1316159056
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHOALWATER BAY INDIAN TRIBE
Doing business as
Shoalwater Bay Tribal Clinic
Practice address
2373 Old Tokeland Rd
Tokeland, WA 98590
Phone
(360) 267-0119
Fax
(360) 267-0417
NPI assigned
May 4, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Ms. Carol Johnson
Title
Tribal Administrator
Phone
(360) 267-6766

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2373 Old Tokeland Rd
Tokeland, WA 98590

Mailing address

PO Box 500
Tokeland, WA 98590-0500
Phone (360) 267-0199

Other names 1

  • Shoalwater Bay Tribal Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shoalwater Bay Tribal C7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316159056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "city": "TOKELAND",
            "state": "WA",
            "postal_code": "985900500",
            "telephone_number": "360-267-0199",
            "fax_number": "360-267-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 OLD TOKELAND RD",
            "city": "TOKELAND",
            "state": "WA",
            "postal_code": "98590",
            "telephone_number": "360-267-0119",
            "fax_number": "360-267-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOALWATER BAY INDIAN TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "TRIBAL ADMINISTRATOR",
        "authorized_official_telephone_number": "360-267-6766",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shoalwater Bay Tribal Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tokeland, 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.