Provider Demographics
NPI:1457506081
Name:SKOKOMISH TRIBAL COUNCIL
Entity Type:Organization
Organization Name:SKOKOMISH TRIBAL COUNCIL
Other - Org Name:SKOKOMISH TRIBE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGSHORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-426-5755
Mailing Address - Street 1:100 N TRIBAL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SKOKOMISH NATION
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9748
Mailing Address - Country:US
Mailing Address - Phone:360-426-5755
Mailing Address - Fax:360-877-2032
Practice Address - Street 1:100 N TRIBAL CENTER RD
Practice Address - Street 2:
Practice Address - City:SKOKOMISH NATION
Practice Address - State:WA
Practice Address - Zip Code:98584-9748
Practice Address - Country:US
Practice Address - Phone:360-426-5755
Practice Address - Fax:360-877-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5021258Medicaid
WA1007457Medicaid
WA5400072Medicaid