Provider Demographics
NPI:1457542847
Name:QUINAULT INDIAN NATION
Entity Type:Organization
Organization Name:QUINAULT INDIAN NATION
Other - Org Name:ROGER SAUX HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-276-4405
Mailing Address - Street 1:1505 KLA-OOK-WA DR
Mailing Address - Street 2:
Mailing Address - City:TAHOLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98587
Mailing Address - Country:US
Mailing Address - Phone:360-276-4405
Mailing Address - Fax:360-276-4474
Practice Address - Street 1:1505 KLA-OOK-WA DR
Practice Address - Street 2:
Practice Address - City:TAHOLAH
Practice Address - State:WA
Practice Address - Zip Code:98587
Practice Address - Country:US
Practice Address - Phone:360-276-4405
Practice Address - Fax:360-276-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FEDERAL FACILITY261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7082191Medicaid