Provider Demographics
NPI:1588789416
Name:COLVILE NATIONS COMMUNITY HEALTH CENTERS
Entity type:Organization
Organization Name:COLVILE NATIONS COMMUNITY HEALTH CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-722-7637
Mailing Address - Street 1:39 SHORTCUT ROAD
Mailing Address - Street 2:PO BOX 290
Mailing Address - City:INCHELIUM
Mailing Address - State:WA
Mailing Address - Zip Code:99138-0290
Mailing Address - Country:US
Mailing Address - Phone:509-722-7006
Mailing Address - Fax:509-722-3652
Practice Address - Street 1:39 SHORTCUT ROAD
Practice Address - Street 2:
Practice Address - City:INCHELIUM
Practice Address - State:WA
Practice Address - Zip Code:99138-0290
Practice Address - Country:US
Practice Address - Phone:509-722-7006
Practice Address - Fax:509-722-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6008767Medicaid