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Organization
COWLITZ INDIAN TRIBE
Active
Organization
COWLITZ INDIAN TRIBE
Active
Other names
Cowlitz Indian Tribal Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
SHAVON KELLER (BILLING SUPERVISOR)
(360) 353-9431
Entity
Organization
Contact information
Practice address
1044 11TH AVE, LONGVIEW, WA 98632
(360) 575-8275
Mailing address
PO BOX 2429, LONGVIEW, WA 98632-8486
(360) 575-8275
(360) 575-1950
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
—
NULL
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
261Q00000X
Clinic/Center
—
NULL
261QH0100X
Health Service Clinic/Center
—
NULL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
NULL
Other
Enumeration date
06/27/2006
Last updated
10/31/2024
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