Provider Demographics
NPI:1912205378
Name:SHOSHONE PAIUTE TRIBES
Entity Type:Organization
Organization Name:SHOSHONE PAIUTE TRIBES
Other - Org Name:OWYHEE COMMUNITY HEALTH FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING TRIBAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RULAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-757-2415
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:OWYHEE
Mailing Address - State:NV
Mailing Address - Zip Code:89832-0130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1623 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:OWYHEE
Practice Address - State:NV
Practice Address - Zip Code:89832-1200
Practice Address - Country:US
Practice Address - Phone:775-757-2415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2015-04-07
Deactivation Date:2013-08-13
Deactivation Code:
Reactivation Date:2013-12-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2992584OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2992584OtherNCPDP PROVIDER IDENTIFICATION NUMBER