Organization
COWLITZ INDIAN TRIBE
Active
Parent organization
COWLITZ INDIAN TRIBE
Other names
Cowlitz Tribal Health Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
COWLITZ INDIAN TRIBE
Authorized official
SHAVON KELLER (BILLING SUPERVISOR)
(360) 353-9431
Entity
Organization
Contact information
Practice address
15455 65TH AVE S, TUKWILA, WA 98188
(206) 721-5170
(206) 721-6288
Mailing address
PO BOX 2429, LONGVIEW, WA 98632-8486
(206) 721-5170
(206) 721-6288
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
10/29/2012
Last updated
02/03/2023
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