NPIMap

Organization Active NPI

Cowlitz Indian Tribe

  • Clinic/Center
  • Longview, WA
National Provider Identifier
1740562909
Registry record updated Mar 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
COWLITZ INDIAN TRIBE
Practice address
1044 11TH Ave
Longview, WA 98632-2506
Phone
(360) 575-8275
Fax
(360) 575-1948
NPI assigned
Sep 14, 2011
Last updated
Mar 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2018

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

Authorized official

Name
Shavon Keller
Title
Billing Supervisor
Phone
(360) 353-9431

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
Health Service Clinic/Center 261QH0100X NU

Addresses

Primary practice location

1044 11TH Ave
Longview, WA 98632-2506

Mailing address

PO Box 2429
Longview, WA 98632-8486
Phone (360) 575-8275

Other identifiers 1

IdentifierTypeStateIssuer
7122898MedicaidWA

Other names 1

  • Cowlitz Indian Tribal Health Services Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050526000589 TX Part B Supplier - Clinic/Group Practice 8820030133 Receives reassigned benefits from 43 practitioners
3 other NPIs on this enrollment
Practice locations: Longview, WA; Ridgefield, WA; Toledo, WA; Tukwila, WA; Vancouver, WA; Dupont, WA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Cowlitz Indian Tribe10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 47

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 47

NPI Registry JSON

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

{
    "created_epoch": "1315958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521676800000",
    "number": "1740562909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2429",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986328486",
            "telephone_number": "360-575-8275",
            "fax_number": "360-575-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 11TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322506",
            "telephone_number": "360-575-8275",
            "fax_number": "360-575-1948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COWLITZ INDIAN TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-14",
        "last_updated": "2018-03-22",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "SHAVON",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "360-353-9431"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7122898",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cowlitz Indian Tribal Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; 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.

Verify at the official NPI Registry.