NPIMap

Organization Active NPI

Cowlitz Indian Tribe

  • Health Service Clinic/Center
  • Toledo, WA
National Provider Identifier
1861722258
Registry record updated Jul 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
COWLITZ INDIAN TRIBE
Practice address
107 Spencer Rd
Toledo, WA 98591
Phone
(360) 353-9431
Fax
(360) 353-9440
NPI assigned
Jan 6, 2010
Organization subpart
Yes
Parent organization
COWLITZ INDIAN TRIBEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 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 1

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

Addresses

Primary practice location

107 Spencer Rd
Toledo, WA 98591

Mailing address

PO Box 2429
Longview, WA 98632-8486
Phone (360) 353-9431

Other practice location 1

1 Cowlitz Way
Ridgefield, WA 98642-5487
Phone (360) 575-8275

National Provider Directory

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

Other organizations with this tax ID 9

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

Locations

1 Cowlitz Way
Ridgefield, WA 98642
Phone (360) 575-3314

107 Spencer Rd
Toledo, WA 98591
Phone (360) 353-9431

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1262736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531699200000",
    "number": "1861722258",
    "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": "360-353-9431",
            "fax_number": "360-353-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 SPENCER RD",
            "city": "TOLEDO",
            "state": "WA",
            "postal_code": "98591",
            "telephone_number": "360-353-9431",
            "fax_number": "360-353-9440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Cowlitz Way",
            "address_purpose": "LOCATION",
            "city": "Ridgefield",
            "state": "WA",
            "postal_code": "986425487",
            "country_code": "US",
            "telephone_number": "360-575-8275",
            "fax_number": "360-353-9440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COWLITZ INDIAN TRIBE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COWLITZ INDIAN TRIBE",
        "enumeration_date": "2010-01-06",
        "last_updated": "2018-07-16",
        "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": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2018; 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.