Provider Demographics
NPI:1215192976
Name:FORT HALL INDIAN HEALTH SERVICES
Entity Type:Organization
Organization Name:FORT HALL INDIAN HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MORIONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-238-2400
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:MISSION RD
Mailing Address - City:FORT HALL
Mailing Address - State:ID
Mailing Address - Zip Code:83203-0717
Mailing Address - Country:US
Mailing Address - Phone:208-238-2400
Mailing Address - Fax:
Practice Address - Street 1:MISSION RD
Practice Address - Street 2:
Practice Address - City:FORT HALL
Practice Address - State:ID
Practice Address - Zip Code:83203-0717
Practice Address - Country:US
Practice Address - Phone:208-238-2400
Practice Address - Fax:208-238-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID19317261QP0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal