Active NPI
Nisqually Indian Tribe
- Clinic/Center
- Olympia, WA
National Provider Identifier
1477745925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- NISQUALLY INDIAN TRIBE
- Practice address
- 4840 Journey St SE
Olympia, WA 98513-6779 - Phone
- (360) 459-5312
- Fax
- (360) 407-0860
- NPI assigned
- Aug 17, 2007
- Last updated
- Jan 10, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael Christensen
- Title
- Clinic Administrator
- Phone
- (360) 459-5312
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | WA | Primary |
Addresses
Primary practice location
4840 Journey St SE
Olympia, WA 98513-6779
Mailing address
4840 Journey St SE
Olympia, WA 98513-6779
Phone (360) 459-5312
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7230055 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 7
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": "1187308800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1736467200000",
"number": "1477745925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4840 JOURNEY ST SE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985136779",
"telephone_number": "360-459-5312",
"fax_number": "360-407-0860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4840 JOURNEY ST SE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985136779",
"telephone_number": "360-459-5312",
"fax_number": "360-407-0860"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NISQUALLY INDIAN TRIBE",
"organizational_subpart": "NO",
"enumeration_date": "2007-08-17",
"last_updated": "2025-01-10",
"certification_date": "2025-01-10",
"status": "A",
"authorized_official_last_name": "CHRISTENSEN",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
"authorized_official_telephone_number": "360-459-5312"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "WA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7230055",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; 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.