Provider Demographics
NPI:1104901941
Name:JAMESTOWN S'KLALLAM TRIBE
Entity type:Organization
Organization Name:JAMESTOWN S'KLALLAM TRIBE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRIBAL CHAIRMAN/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:W.
Authorized Official - Middle Name:RON
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-683-1109
Mailing Address - Street 1:526 S 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3626
Mailing Address - Country:US
Mailing Address - Phone:360-681-7755
Mailing Address - Fax:360-681-5999
Practice Address - Street 1:526 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3626
Practice Address - Country:US
Practice Address - Phone:360-681-7755
Practice Address - Fax:360-681-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1981141Medicaid