Provider Demographics
NPI:1023195161
Name:JAMESTOWN S'KLALLAM TRIBE
Entity Type:Organization
Organization Name:JAMESTOWN S'KLALLAM TRIBE
Other - Org Name:JAMESTOWN HEALING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRIBAL CHAIRMAN/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:W.
Authorized Official - Middle Name:RON
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-683-1109
Mailing Address - Street 1:526 S 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3626
Mailing Address - Country:US
Mailing Address - Phone:360-681-7755
Mailing Address - Fax:360-681-5999
Practice Address - Street 1:526 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3626
Practice Address - Country:US
Practice Address - Phone:360-681-7755
Practice Address - Fax:360-681-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1991355Medicaid