Provider Demographics
NPI:1639210370
Name:OMAK TRIBAL HEALTH CLINIC
Entity Type:Organization
Organization Name:OMAK TRIBAL HEALTH CLINIC
Other - Org Name:DHHS IHS COLVILLE SERVICE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MISIASZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-634-2900
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:NESPELEM
Mailing Address - State:WA
Mailing Address - Zip Code:99155-0071
Mailing Address - Country:US
Mailing Address - Phone:509-634-2900
Mailing Address - Fax:509-634-2990
Practice Address - Street 1:617 BENTON STREET
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-0962
Practice Address - Country:US
Practice Address - Phone:509-634-2900
Practice Address - Fax:509-634-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6026850Medicaid