Organization
COWLITZ INDIAN TRIBE
Active
Parent organization
COWLITZ INDIAN TRIBE
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
107 SPENCER RD, TOLEDO, WA 98591
(360) 353-9431
(360) 353-9440
Mailing address
PO BOX 2429, LONGVIEW, WA 98632-8486
(360) 353-9431
(360) 353-9440
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
01/06/2010
Last updated
07/16/2018
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