Provider Demographics
| NPI: | 1316056096 |
|---|---|
| Name: | SKOKOMISH TRIBAL COUNCIL |
| Entity type: | Organization |
| Organization Name: | SKOKOMISH TRIBAL COUNCIL |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | BUSINESS OFFICE MANAGER |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | FRANCES |
| Authorized Official - Middle Name: | L |
| Authorized Official - Last Name: | LONGSHORE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 360-426-5755 |
| Mailing Address - Street 1: | 100 N TRIBAL CENTER RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SKOKOMISH NATION |
| Mailing Address - State: | WA |
| Mailing Address - Zip Code: | 98584-9748 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 360-426-5755 |
| Mailing Address - Fax: | 360-877-2032 |
| Practice Address - Street 1: | 100 N TRIBAL CENTER RD |
| Practice Address - Street 2: | |
| Practice Address - City: | SKOKOMISH NATION |
| Practice Address - State: | WA |
| Practice Address - Zip Code: | 98584-9748 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 360-426-5755 |
| Practice Address - Fax: | 360-877-2032 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-08-29 |
| Last Update Date: | 2012-02-08 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207QA0000X | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty | |
| No | 124Q00000X | Dental Providers | Dental Hygienist | Group - Multi-Specialty | |
| No | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Multi-Specialty |
| No | 1223P0221X | Dental Providers | Dentist | Pediatric Dentistry | Group - Multi-Specialty |
| No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
| No | 174H00000X | Other Service Providers | Health Educator | Group - Multi-Specialty | |
| No | 176B00000X | Other Service Providers | Midwife | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WA | 2000539 | Medicaid | |
| WA | 1980796 | Medicaid | |
| WA | 1981067 | Medicaid | |
| WA | 7057508 | Medicaid | |
| WA | 1044601 | Medicaid | |
| WA | 7133473 | Medicaid | |
| WA | 1007457 | Medicaid | |
| WA | 5400072 | Medicaid | |
| WA | 7048267 | Medicaid | |
| WA | 2031961 | Medicaid | |
| WA | 1042775 | Medicaid | |
| WA | 1991512 | Medicaid | |
| WA | 5021258 | Medicaid | |
| WA | TRZ016 | Medicare PIN |
