Provider Demographics
NPI:1619069986
Name:ALABAMA-COUSHATTA TRIBE OF TEXAS
Entity Type:Organization
Organization Name:ALABAMA-COUSHATTA TRIBE OF TEXAS
Other - Org Name:CHIEF KINA HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SYLESTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-563-2058
Mailing Address - Street 1:129 DAYCARE RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-0061
Mailing Address - Country:US
Mailing Address - Phone:936-563-2058
Mailing Address - Fax:936-563-2731
Practice Address - Street 1:129 DAYCARE RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-0061
Practice Address - Country:US
Practice Address - Phone:936-563-2058
Practice Address - Fax:936-563-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center