Provider Demographics
NPI:1942331517
Name:EASTERN BAND OF CHEROKEE INDIANS
Entity Type:Organization
Organization Name:EASTERN BAND OF CHEROKEE INDIANS
Other - Org Name:CHEROKEE COUNTY CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:828-497-7458
Mailing Address - Street 1:328 OLD AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:MARBLE
Mailing Address - State:NC
Mailing Address - Zip Code:28905
Mailing Address - Country:US
Mailing Address - Phone:828-837-4312
Mailing Address - Fax:
Practice Address - Street 1:328 OLD AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:MARBLE
Practice Address - State:NC
Practice Address - Zip Code:28905
Practice Address - Country:US
Practice Address - Phone:828-837-4312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC341902Medicare Oscar/Certification