Provider Demographics
NPI:1609068170
Name:MAKAH TRIBE
Entity Type:Organization
Organization Name:MAKAH TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-645-2233
Mailing Address - Street 1:171 MAKAH BAY DR
Mailing Address - Street 2:PO BOX 410
Mailing Address - City:NEAH BAY
Mailing Address - State:WA
Mailing Address - Zip Code:98357
Mailing Address - Country:US
Mailing Address - Phone:360-645-3282
Mailing Address - Fax:360-645-2246
Practice Address - Street 1:171 MAKAH BAY DR
Practice Address - Street 2:
Practice Address - City:NEAH BAY
Practice Address - State:WA
Practice Address - Zip Code:98357
Practice Address - Country:US
Practice Address - Phone:360-645-3282
Practice Address - Fax:360-645-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)