Provider Demographics
NPI:1568810885
Name:COLVILLE INDIAN HEALTH SERVICE
Entity Type:Organization
Organization Name:COLVILLE INDIAN HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NANAMKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-634-2913
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:19 LAKES STREET
Mailing Address - City:NESPELEM
Mailing Address - State:WA
Mailing Address - Zip Code:99155-0071
Mailing Address - Country:US
Mailing Address - Phone:509-634-2913
Mailing Address - Fax:509-634-2946
Practice Address - Street 1:19 LAKES STREET
Practice Address - Street 2:
Practice Address - City:NESPELEM
Practice Address - State:WA
Practice Address - Zip Code:99155
Practice Address - Country:US
Practice Address - Phone:509-634-2913
Practice Address - Fax:509-634-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89612261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center