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 98632-2506
(360) 575-8275
(360) 575-1948
Mailing address
PO BOX 2429, LONGVIEW, WA 98632-8486
(360) 575-8275
(360) 575-1950
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7122898
—
WA
Enumeration date
09/14/2011
Last updated
03/22/2018
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