Provider Demographics
NPI:1588805832
Name:KLAMATH TRIBAL HEALTH & FAMILY SERVICES
Entity Type:Organization
Organization Name:KLAMATH TRIBAL HEALTH & FAMILY SERVICES
Other - Org Name:KLAMATH TRIBAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-783-2438
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:CHILOQUIN
Mailing Address - State:OR
Mailing Address - Zip Code:97624-0490
Mailing Address - Country:US
Mailing Address - Phone:541-783-2438
Mailing Address - Fax:541-783-3554
Practice Address - Street 1:330 CHILOQUIN BOULEVARD
Practice Address - Street 2:
Practice Address - City:CHILOQUIN
Practice Address - State:OR
Practice Address - Zip Code:97624
Practice Address - Country:US
Practice Address - Phone:541-783-2438
Practice Address - Fax:541-783-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2612F0400X261Q00000X
332800000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181550Medicaid
OR0901800001Medicare NSC