Provider Demographics
NPI:1043263742
Name:TULALIP TRIBES HEALTH CLINIC
Entity Type:Organization
Organization Name:TULALIP TRIBES HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:I
Authorized Official - Last Name:FRYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-651-4515
Mailing Address - Street 1:7520 TOTEM BEACH RD
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271
Mailing Address - Country:US
Mailing Address - Phone:360-651-4511
Mailing Address - Fax:360-651-9451
Practice Address - Street 1:7520 TOTEM BEACH RD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271
Practice Address - Country:US
Practice Address - Phone:360-651-4511
Practice Address - Fax:360-651-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0096092OtherLABOR INDUSTRIES
WA7056880Medicaid
WA0096092OtherLABOR INDUSTRIES