Provider Demographics
NPI:1043216021
Name:UNITED INDIAN HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:UNITED INDIAN HEALTH SERVICES, INC.
Other - Org Name:TAA-'AT-DVN
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-825-4065
Mailing Address - Street 1:1600 WEEOT WAY
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4734
Mailing Address - Country:US
Mailing Address - Phone:707-825-5000
Mailing Address - Fax:707-825-6747
Practice Address - Street 1:1675 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8928
Practice Address - Country:US
Practice Address - Phone:707-464-2750
Practice Address - Fax:707-464-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 251S00000X, 261QP2300X, 261QP2300X
CAEXEMPT261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATHP70830FMedicaid
CAZZZ78038ZMedicare PIN