PORT GAMBLE S'KLALLAM TRIBE (NPI# 1760428650) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760428650 |
| Entity Type | Organization |
| Organization Name | PORT GAMBLE S'KLALLAM TRIBE |
| Other Organization Name | PORT GAMBLE S'KLALLAM HEALTH CENTER |
| Practice Address |
32014 Little Boston Rd Ne Kingston WA 98346-9734 |
| Practice Telephone | 3602979601 |
| Practice Fax Number | 3602979614 |
| Mailing Telephone | 3602979601 |
| Mailing Fax Number | 3602979614 |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2011-01-07 |
| Authorized Official Name | DALLAS I DEGUIRE (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Telephone | 3602979601 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | L&I CLINIC ID# | 0101820 | 01 |
| WA | 5031794 | 05 | |
| WA | 7094964 | 05 | |
| WA | 7094972 | 05 | |
| WA | 1992825 | 05 | |
| WA | 5031810 | 05 | |
| WA | 1980929 | 05 | |
| WA | REGENCE RIDER# | PO1021 | 01 |
| Other Name | Type Code |
|---|---|
| Port Gamble S'Klallam Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518585579 | Port Gamble S'klallam Tribe | Clinic/Center | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2020-07-07 |
| Street Address |
32014 LITTLE BOSTON RD NE |
| City | KINGSTON |
| State | WA |
| Zip Code | 98346-9734 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942257027 | Piero Francis Sandri | Specialist | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2006-05-27 |
| 1518585579 | Port Gamble S'klallam Tribe | Clinic/Center | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2020-07-07 |
| 1467874156 | Lane Daniel | Counselor | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2014-01-14 |
| 1902056955 | Dorie M Salem-soule | Dental Hygienist | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2008-09-26 |
| 1447418785 | Katarzyna Hoskins | Counselor | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2008-05-22 |
| 1417114869 | Deanna Griffeth | Counselor | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2008-05-21 |
| 1760677140 | Carol J Croff | Registered Nurse | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2007-09-10 |
| 1952596629 | Holly A Blanton | Registered Nurse | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2007-09-06 |
| 1043435563 | Port Gamble S'klallam Orca Pride | Clinic/Center | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2007-04-17 |
| 1649391871 | Port Gamble S'klallam Social Services | Clinic/Center | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2007-04-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831725688 | Sierra Joye Lari | Massage Therapist | 8202 Ne Highway 104, Suite 105, Kingston, WA 98346 | 2020-03-12 |
| 1235641705 | Reba Lee Harris | Counselor | 7550 Little Boston Road N.e, Kingston, WA 98346 | 2017-10-24 |
| 1134592421 | Honeycomb Medical Services, A Med Corp | Physician Assistant | 700 Alamo Pintado Road, Solvang, CA 98346 | 2015-11-09 |
| 1588000764 | Donald G Hill | Contractor | 26325 Ne Illinois Ave, B 105, Kingston, WA 98346 | 2013-05-15 |
| 1104161900 | Marcus Dean Atkinson | Massage Therapist | 8202 Ne Hwy 104, Ste 105, Kingston, WA 98346 | 2012-12-05 |
| 1245580687 | Samantha Christine Kottke | Massage Therapist | 25960 Ohio Ave Suite 206, Kingston, WA 98346 | 2012-09-13 |
| 1265713390 | Karen Dale Friend | Pharmacist | 8196 State Highway 104, Kingston, WA 98346 | 2011-09-02 |
| 1750526323 | Megan Elizabeth Pratt | Mechanotherapist | 25925 Washington Blvd., Kingston, WA 98346 | 2008-12-10 |
| 1073787412 | Cindy Pamela Haines | Massage Therapist | 25925 Washington Boulevard Ne, Kingston, WA 98346 | 2008-04-16 |
| 1417163031 | Dian Aletha Poyssick | Pharmacist | 8196 State Route 104, Kingston, WA 98346 | 2007-05-14 |
| Find all providers in zip 98346 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518585579 | Port Gamble S'klallam Tribe | Clinic/Center | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2020-07-07 |
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| 1952422354 | Luzerne Wyoming County Mh Center #1 | Clinic/Center | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2007-04-03 |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.