SHOALWATER BAY TRIBAL CLINIC (SHOALWATER BAY INDIAN TRIBE) NPI 1003028952

Clinic/Center (Dental) in Tokeland, WA

NPI 1003028952 Organization Clinic/Center Dental

About SHOALWATER BAY TRIBAL CLINIC (SHOALWATER BAY INDIAN TRIBE)

Shoalwater Bay Tribal Clinic (shoalwater Bay Indian Tribe) is a provider established in Tokeland, Washington specializing in clinic/center (dental) . The NPI number of Shoalwater Bay Tribal Clinic (shoalwater Bay Indian Tribe) is 1003028952 and was assigned on May 2007. The practitioner's primary taxonomy code is 261QD0000X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's is doing business as Shoalwater Bay Tribal Clinic. The authorized official of this NPI record is Ms. Carol Johnson (Tribal Administrator)

NPI

1003028952

Provider NameSHOALWATER BAY TRIBAL CLINIC (SHOALWATER BAY INDIAN TRIBE)
Provider Location Address2373 OLD TOKELAND RD TOKELAND, WA 98590
Provider Mailing AddressPO BOX 500 TOKELAND, WA 98590
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameSHOALWATER BAY TRIBAL CLINIC
Other Name TypeDoing Business As (3)
Enumeration Date05-04-2007
Last Update Date08-22-2020


Primary Taxonomy

Taxonomy Code261QD0000X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationDental

Business Address

SHOALWATER BAY TRIBAL CLINIC
2373 OLD TOKELAND RD
TOKELAND, WA
ZIP 98590
Phone: (360) 267-8103
Fax: (360) 267-1437

Get Directions


Mailing Address

SHOALWATER BAY TRIBAL CLINIC
PO BOX 500
TOKELAND, WA
ZIP 98590
Phone: (360) 267-0119
Fax: (360) 267-0417



Authorized Official

Authorized Official NameMS. CAROL JOHNSON
Authorized Official TitleTRIBAL ADMINISTRATOR
Authorized Official Phone(360) 267-6766

Other Providers at the same location


The following 7 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1689886475MRS. PAMELA J KORZENIOWSKI PAC
Individual
Physician Assistant (Medical)2373 OLD TOKELAND RD
TOKELAND, WA 98590
(360) 267-0119
1699987487MS. JEANNE PAUL LMFT
Individual
Marriage & Family Therapist2373 OLD TOKELAND RD
TOKELAND, WA 98590
(360) 267-2508
1679785463DR. GREGORY DALE CEBULLA DDS
Individual
Dentist (General Practice)2373 OLD TOKELAND RD
TOKELAND, WA 98590
(360) 267-8103
1063624740SHOALWATER BAY TRIBE
Organization
Clinic/Center (Primary Care)2373 OLD TOKELAND RD
TOKELAND, WA 98590
(360) 267-0119
1316159056SHOALWATER BAY INDIAN TRIBE
Organization
Clinic/Center (Federally Qualified Health Center (FQHC))2373 OLD TOKELAND RD
TOKELAND, WA 98590
(360) 267-0119
1104038926SHOALWATER BAY INDIAN TRIBE
Organization
Community/Behavioral Health2373 OLD TOKELAND RD
TOKELAND, WA 98590
(360) 267-3408
1447462700SHOALWATER BAY INDIAN TRIBE
Organization
Clinic/Center (Mental Health (Including Community Mental Health Center))2373 OLD TOKELAND RD
TOKELAND, WA 98590
(360) 267-2508

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.