Provider Demographics
NPI:1609882976
Name:SENECA NATION OF INDIANS
Entity Type:Organization
Organization Name:SENECA NATION OF INDIANS
Other - Org Name:LIONEL R JOHN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-532-5582
Mailing Address - Street 1:987 R C HOAG DR
Mailing Address - Street 2:
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-1365
Mailing Address - Country:US
Mailing Address - Phone:716-945-5894
Mailing Address - Fax:716-945-5889
Practice Address - Street 1:987 R C HOAG DR
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1365
Practice Address - Country:US
Practice Address - Phone:716-945-5894
Practice Address - Fax:716-242-6345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENECA NATION OF INDIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
970085OtherUNITED CONCORDIA GROUP #
NY03108298Medicaid
NYA1872OtherHEALTHPLEX INS
5501170OtherGHI GROUP #
NYGRP512009001OtherWNY BC/BS GROUP #
NY01649476Medicaid
NY03108298Medicaid
NY01649476Medicaid