# STILLAGUAMISH TRIBAL HEALTH CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164451142
- **Authorized official:** DANNIELLE MARIE HANCOCK (ACCOUNT MANAGER)
- **Authorized official phone:** (360) 631-5971

## Contact information

- **Practice address:** 24205 JAMES DORSEY WAY STE 1, ARLINGTON, WA 98223-6029
- **Practice address phone:** (360) 435-9338
- **Practice address fax:** (360) 435-2266
- **Mailing address:** 24205 JAMES DORSEY WAY STE 1, ARLINGTON, WA 98223-6029
- **Mailing address phone:** (360) 435-9338
- **Mailing address fax:** (360) 435-2266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261QC1500X | Community Health Clinic/Center | AP30001255 | WA | — |
| 261QP2300X | Primary Care Clinic/Center | AP30001255 | WA | — |

## Other

- **Enumeration date:** 07/01/2006
- **Last updated:** 08/18/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2093558 | — | WA |
| 05 | — | 8456352 | — | WA |
| 05 | — | 9600198 | — | WA |