Provider Demographics
NPI:1346283488
Name:YELLOWHAWK TRIBAL HEALTH CENTER
Entity Type:Organization
Organization Name:YELLOWHAWK TRIBAL HEALTH CENTER
Other - Org Name:YELLOWHAWK TRIBAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HETTINGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-966-9830
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0160
Mailing Address - Country:US
Mailing Address - Phone:541-966-9830
Mailing Address - Fax:
Practice Address - Street 1:46314 TIMINE WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9417
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500774697Medicaid
ORTRZ021OtherMEDICARE