Provider Demographics
NPI:1427171628
Name:ROGER SAUX HEALTH CENTER
Entity type:Organization
Organization Name:ROGER SAUX HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-276-4405
Mailing Address - Street 1:1505 KLA-OOK-WAH DR
Mailing Address - Street 2:
Mailing Address - City:TAHOLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98587
Mailing Address - Country:US
Mailing Address - Phone:360-276-4405
Mailing Address - Fax:360-276-4474
Practice Address - Street 1:1505 KLAOOKWA DRIVE
Practice Address - Street 2:
Practice Address - City:TAHOLAH
Practice Address - State:WA
Practice Address - Zip Code:98587
Practice Address - Country:US
Practice Address - Phone:360-276-4405
Practice Address - Fax:360-276-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFEDERAL332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4924963OtherNABP
WAAT5011666OtherDEA
WAAT5011666OtherDEA