Provider Demographics
NPI:1326173105
Name:NOT TSOO GAH NEE INDIAN HEALTH SERVICES
Entity Type:Organization
Organization Name:NOT TSOO GAH NEE INDIAN HEALTH SERVICES
Other - Org Name:FORT HALL INDIAN HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-238-5493
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
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:208-238-5463
Practice Address - Street 1:MISSION ROAD
Practice Address - Street 2:MISSION ROAD
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:2007-02-22
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003398400Medicaid
IDHSZ205Medicare ID - Type Unspecified