NPIMap

Organization Active NPI

Cowlitz Indian Tribe

  • Public Health & General Preventive Medicine Physician
  • Vancouver, WA
National Provider Identifier
1972962165
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
Legal business name
COWLITZ INDIAN TRIBE
Practice address
7700 NE 26TH Ave
Vancouver, WA 98665-0672
Phone
(360) 397-8228
Fax
(360) 575-1950
NPI assigned
Feb 16, 2016
Organization subpart
Yes
Parent organization
COWLITZ INDIAN TRIBEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health & General Preventive Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0901X Primary
Health Service Clinic/Center 261QH0100X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

7700 NE 26TH Ave
Vancouver, WA 98665-0672

Mailing address

PO Box 2429
Longview, WA 98632-8486
Phone (360) 397-8228

Other names 1

  • Cowlitz Indian Tribal Health Services Other name

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.

Practitioners & affiliated clinicians

Practitioners 10

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": "1455580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675382400000",
    "number": "1972962165",
    "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": "360-397-8228",
            "fax_number": "360-575-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 NE 26TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986650672",
            "telephone_number": "360-397-8228",
            "fax_number": "360-575-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COWLITZ INDIAN TRIBE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COWLITZ INDIAN TRIBE",
        "enumeration_date": "2016-02-16",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "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": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "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 Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; 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.