NPIMap

Organization Active NPI

Klamath Tribal Health & Family Services

  • Federally Qualified Health Center (FQHC)
  • Chiloquin, OR
National Provider Identifier
1629078274
Registry record updated Mar 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KLAMATH TRIBAL HEALTH & FAMILY SERVICES
Practice address
330 Chiloquin Blvd
Chiloquin, OR 97624
Phone
(541) 783-2438
Fax
(541) 783-3273
NPI assigned
Jul 26, 2005
Last updated
Mar 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2023

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

Authorized official

Name
Nikowa Nicole Mendez, MHA, BSN, RN, THRP
Title
Compliance Administrator
Phone
(541) 882-1487

Specialties & licenses 1

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

Addresses

Primary practice location

330 Chiloquin Blvd
Chiloquin, OR 97624

Mailing address

3949 South 6TH Street
Klamath Falls, OR 97603-4746
Phone (541) 882-1487

Other practice location 1

6000 New Way
Klamath Falls, OR 97601-9382
Phone (541) 882-1487

Other identifiers 1

IdentifierTypeStateIssuer
129861MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20021205000018 OR Part A Provider - Federally Qualified Health Center (FQHC) 9032027206 Practice locations: Chiloquin, OR
O20040408001359 OR Part B Supplier - Clinic/Group Practice 9032027206 Receives reassigned benefits from 16 practitioners
Practice locations: Chiloquin, OR; Klamath Falls, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629078274. Details of each certification follow.

Federally qualified health center certification: CCN 381849

Legal name
KLAMATH TRIBAL HEALTH & FAMILY SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 1, 2003
Last certification
Feb 1, 2003
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
330 S Chiloquin Blvd
Chiloquin, OR 97624-6747

National Provider Directory

National Provider Directory
Tax ID family
Klamath Tribal Health6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Laurie Westenberg Individual Operational/Managerial Control Jan 1, 2025 100%
Klamath Tribal Health & Family Services Organization, Klamath Falls, OR Operational/Managerial Control Jan 1, 1997 100%

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1629078274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3949 SOUTH 6TH STREET",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976034746",
            "telephone_number": "541-882-1487",
            "fax_number": "541-882-8277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 CHILOQUIN BLVD",
            "city": "CHILOQUIN",
            "state": "OR",
            "postal_code": "97624",
            "telephone_number": "541-783-2438",
            "fax_number": "541-783-3273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6000 New Way",
            "address_purpose": "LOCATION",
            "city": "Klamath Falls",
            "state": "OR",
            "postal_code": "976019382",
            "country_code": "US",
            "telephone_number": "541-882-1487",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KLAMATH TRIBAL HEALTH & FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "MENDEZ",
        "authorized_official_first_name": "NIKOWA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "COMPLIANCE ADMINISTRATOR",
        "authorized_official_telephone_number": "541-882-1487",
        "authorized_official_credential": "MHA, BSN, RN, THRP"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129861",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chiloquin, OR

Sources for this page

Verify at the official NPI Registry.