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Organization

COWLITZ INDIAN TRIBE

Active
Parent organization
COWLITZ INDIAN TRIBE
Other names
Cowlitz Indian 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
900 FIR ST, LONGVIEW, WA 98632-2544
(360) 353-9422
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
Primary
261QH0100X
Health Service Clinic/Center
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1981224
WA
Enumeration date
04/19/2007
Last updated
10/31/2024
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