Provider Demographics
NPI:1134179161
Name:EASTERN BAND OF CHEROKEE INDIANS
Entity type:Organization
Organization Name:EASTERN BAND OF CHEROKEE INDIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF TREASURY
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-359-6000
Mailing Address - Street 1:PO BOX 63303
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3303
Mailing Address - Country:US
Mailing Address - Phone:855-626-9660
Mailing Address - Fax:937-291-2971
Practice Address - Street 1:969 ACQUONI ROAD
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-497-1085
Practice Address - Fax:828-497-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12063416L0300X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406821Medicaid
NC0123KOtherBCBS NC
NC3406821Medicaid