# COWLITZ INDIAN TRIBE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cowlitz Indian Tribal Health Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851328447
- **Authorized official:** SHAVON KELLER (BILLING SUPERVISOR)
- **Authorized official phone:** (360) 353-9431

## Contact information

- **Practice address:** 1044 11TH AVE, LONGVIEW, WA 98632
- **Practice address phone:** (360) 575-8275
- **Mailing address:** PO BOX 2429, LONGVIEW, WA 98632-8486
- **Mailing address phone:** (360) 575-8275
- **Mailing address fax:** (360) 575-1950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | NULL | — |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 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