NPIMap

Organization Active NPI

Cowlitz Indian Tribe

  • General Practice Physician
  • Longview, WA
National Provider Identifier
1851328447
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
COWLITZ INDIAN TRIBE
Practice address
1044 11TH Ave
Longview, WA 98632
Phone
(360) 575-8275
NPI assigned
Jun 27, 2006
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health & General Preventive Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0901X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Clinic/Center 261Q00000X
Health Service Clinic/Center 261QH0100X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

1044 11TH Ave
Longview, WA 98632

Mailing address

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

Other practice location 1

1000 Davis Pl
DuPont, WA 98327-8781
Phone (206) 721-5170

Other practice location 2

6450 Southcenter Blvd Ste 102
Tukwila, WA 98188-2552
Phone (206) 721-5170

Other practice location 3

900 Fir St
Longview, WA 98632-2544
Phone (360) 575-3316

Other practice location 4

7700 NE 26th Ave
Vancouver, WA 98665-0672
Phone (360) 397-8228

Other practice location 5

15455 65th Ave S
Tukwila, WA 98188-2534
Phone (206) 721-5170

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
This NPI is an additional NPI on the 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

Locations

6450 Southcenter Blvd
Ste 102
Tukwila, WA 98188
Phone (206) 466-5410

7700 NE 26th Ave
Vancouver, WA 98665
Phone (360) 397-8228

Practitioners & affiliated clinicians

Practitioners 49

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 49

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1851328447",
    "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": "98632",
            "telephone_number": "360-575-8275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Davis Pl",
            "address_purpose": "LOCATION",
            "city": "DuPont",
            "state": "WA",
            "postal_code": "983278781",
            "country_code": "US",
            "telephone_number": "206-721-5170",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6450 Southcenter Blvd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Tukwila",
            "state": "WA",
            "postal_code": "981882552",
            "country_code": "US",
            "telephone_number": "206-721-5170",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "900 Fir St",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986322544",
            "country_code": "US",
            "telephone_number": "360-575-3316",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7700 NE 26th Ave",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986650672",
            "country_code": "US",
            "telephone_number": "360-397-8228",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15455 65th Ave S",
            "address_purpose": "LOCATION",
            "city": "Tukwila",
            "state": "WA",
            "postal_code": "981882534",
            "country_code": "US",
            "telephone_number": "206-721-5170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COWLITZ INDIAN TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-27",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "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": "2083P0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Oct 31, 2024; 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.