Provider Demographics
NPI:1154952380
Name:TE-MOAK TRIBE OF WESTERN SHOSHONE
Entity type:Organization
Organization Name:TE-MOAK TRIBE OF WESTERN SHOSHONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EYEWEAR TECH.
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-738-9251
Mailing Address - Street 1:525 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2539
Mailing Address - Country:US
Mailing Address - Phone:775-738-9251
Mailing Address - Fax:775-738-2345
Practice Address - Street 1:525 SUNSET ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2539
Practice Address - Country:US
Practice Address - Phone:775-738-9251
Practice Address - Fax:775-738-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy