NPIMap

Organization Active NPI

Skokomish Tribal Council

Doing business as Skokomish Department of Social Services

  • Adolescent Medicine (Family Medicine) Physician
  • Skokomish Nation, WA
National Provider Identifier
1396056461
Registry record updated Jun 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Family Medicine) PhysicianTaxonomy code 207QA0000X
Legal business name
SKOKOMISH TRIBAL COUNCIL
Doing business as
Skokomish Department of Social Services
Practice address
561 N Tribal Center Rd
Skokomish Nation, WA 98584-7416
Phone
(360) 426-5755
Fax
(360) 402-0082
NPI assigned
Jun 23, 2010
Organization subpart
Yes
Parent organization
SKOKOMISH TRIBAL COUNCILAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2010

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

Authorized official

Name
Frances L Longshore
Title
Business Office Manager
Phone
(360) 426-5755

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Adolescent Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0000X Primary

Addresses

Primary practice location

561 N Tribal Center Rd
Skokomish Nation, WA 98584-7416

Mailing address

561 N Tribal Center Road
Skokomish Nation, WA 98584-9748
Phone (360) 426-5755

Other identifiers 1

IdentifierTypeStateIssuer
1042775MedicaidWA

Other names 1

  • SKOKOMISH DEPARTMENT OF SOCIAL SERVICES Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jonathan Sugarman MD5 organizations share this tax ID, including this one
Part of
Jonathan Sugarman MD

Other organizations with this tax ID 4

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": "1277251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277251200000",
    "number": "1396056461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "561 N TRIBAL CENTER ROAD",
            "city": "SKOKOMISH NATION",
            "state": "WA",
            "postal_code": "985849748",
            "telephone_number": "360-426-5755",
            "fax_number": "360-402-0082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "561 N TRIBAL CENTER RD",
            "city": "SKOKOMISH NATION",
            "state": "WA",
            "postal_code": "985847416",
            "telephone_number": "360-426-5755",
            "fax_number": "360-402-0082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKOKOMISH TRIBAL COUNCIL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SKOKOMISH TRIBAL COUNCIL",
        "enumeration_date": "2010-06-23",
        "last_updated": "2010-06-23",
        "status": "A",
        "authorized_official_last_name": "LONGSHORE",
        "authorized_official_first_name": "FRANCES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "360-426-5755"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1042775",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SKOKOMISH DEPARTMENT OF SOCIAL SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Skokomish Nation, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.