Provider Demographics
NPI:1558441139
Name:NOT TSOO GAH NEE INDIAN HEALTH
Entity Type:Organization
Organization Name:NOT TSOO GAH NEE INDIAN HEALTH
Other - Org Name:NOT TSOO GAH NEE INDIAN HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MORIONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHAKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-238-5456
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:208-238-5456
Mailing Address - Fax:208-238-5463
Practice Address - Street 1:MISSION ROAD
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:208-238-5456
Practice Address - Fax:208-238-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003398900Medicaid
ID003398900Medicaid