Provider Demographics
NPI:1821114026
Name:LOWER ELWHA KLALLAM TRIBE
Entity Type:Organization
Organization Name:LOWER ELWHA KLALLAM TRIBE
Other - Org Name:LOWER ELWHA KLALLAM TRIBE HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRWOMAN
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-452-8471
Mailing Address - Street 1:243511 W HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-9472
Mailing Address - Country:US
Mailing Address - Phone:360-452-6252
Mailing Address - Fax:360-452-6274
Practice Address - Street 1:243511 W HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-9472
Practice Address - Country:US
Practice Address - Phone:360-452-6252
Practice Address - Fax:360-452-6274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50-1835OtherPTAN