Provider Demographics
NPI:1730279423
Name:KARUK TRIBE
Entity Type:Organization
Organization Name:KARUK TRIBE
Other - Org Name:KARUK TRIBAL HEALTH PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRIBAL CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTEBERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-493-1600
Mailing Address - Street 1:PO BOX 1016
Mailing Address - Street 2:
Mailing Address - City:HAPPY CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:96039-1016
Mailing Address - Country:US
Mailing Address - Phone:530-493-1600
Mailing Address - Fax:530-493-1648
Practice Address - Street 1:1519 S OREGON ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3425
Practice Address - Country:US
Practice Address - Phone:530-842-9200
Practice Address - Fax:530-842-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1730279423Medicaid
CAZZZ16552ZOtherBLUE SHIELD OF CALIFORNIA
CA1730279423OtherMEDICARE