Provider Demographics
NPI:1184743221
Name:LUMMI INDIAN BUSINESS COUNCIL
Entity type:Organization
Organization Name:LUMMI INDIAN BUSINESS COUNCIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-312-2285
Mailing Address - Street 1:2592 KWINA RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-312-2285
Mailing Address - Fax:360-312-2336
Practice Address - Street 1:2608 KWINA RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9291
Practice Address - Country:US
Practice Address - Phone:360-384-0464
Practice Address - Fax:360-384-2337
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUMMI INDIAN BUSINESS COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-28
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6022743Medicaid