Provider Demographics
NPI:1952483406
Name:KARUK TRIBE
Entity Type:Organization
Organization Name:KARUK TRIBE
Other - Org Name:KARUK COMMUNITY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRIBAL CHAIRMAN
Authorized Official - Prefix:
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:530-493-5257
Mailing Address - Fax:530-493-5270
Practice Address - Street 1:64236 SECOND AVE
Practice Address - Street 2:
Practice Address - City:HAPPY CAMP
Practice Address - State:CA
Practice Address - Zip Code:96039-1016
Practice Address - Country:US
Practice Address - Phone:530-493-5257
Practice Address - Fax:530-493-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X, 1223G0001X, 208D00000X
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
CAZZZ09861ZOtherBLUE SHIELD OF CALIFORNIA
CA1952483406OtherNPI
CA1952483406OtherMEDICARE
CA1952483406Medicaid