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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
208D00000X
General Practice Physician
Primary
261Q00000X
Clinic/Center
261QH0100X
Health Service Clinic/Center
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center

Other

Enumeration date
06/27/2006
Last updated
10/31/2024
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