Provider Demographics
NPI:1386726032
Name:KARUK TRIBE
Entity type:Organization
Organization Name:KARUK TRIBE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:TIRATERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-493-1600
Mailing Address - Street 1:PO BOX 1016
Mailing Address - Street 2:
Mailing Address - City:HAPPY CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:96039-1016
Mailing Address - Country:US
Mailing Address - Phone:530-493-1600
Mailing Address - Fax:530-493-1648
Practice Address - Street 1:325 ASIP RD
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:CA
Practice Address - Zip Code:95556-0249
Practice Address - Country:US
Practice Address - Phone:530-627-3452
Practice Address - Fax:503-627-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386726032Medicaid
CA1386726032OtherMEDICARE
ZZZ09862ZOtherBLUE SHIELD OF CALIFORNIA