Provider Demographics
NPI:1588795165
Name:EASTERN BAND OF CHEROKEE INDIANS
Entity type:Organization
Organization Name:EASTERN BAND OF CHEROKEE INDIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH CARE BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-359-6194
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719-0666
Mailing Address - Country:US
Mailing Address - Phone:828-497-7458
Mailing Address - Fax:
Practice Address - Street 1:73 KAISER WILNOTY DR
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719-0666
Practice Address - Country:US
Practice Address - Phone:828-359-6240
Practice Address - Fax:828-497-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344572AMedicaid
NC344572CMedicaid
NC344572CMedicaid
NC341904Medicare Oscar/Certification
NC341902Medicare Oscar/Certification
NC344572AMedicaid
NC341903Medicare Oscar/Certification
NC341900Medicare Oscar/Certification