Provider Demographics
NPI:1659457851
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:2006-10-31
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015856332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015856OtherNYS PHARMACY LICENSE
NY3300960OtherNABP
NY01649476Medicaid