Provider Demographics
NPI:1750877437
Name:SOPHIE TRETTEVICK INDIAN HEALTH CENTER
Entity type:Organization
Organization Name:SOPHIE TRETTEVICK INDIAN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HCV/MAT CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:360-645-2233
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:NEAH BAY
Mailing Address - State:WA
Mailing Address - Zip Code:98357-0410
Mailing Address - Country:US
Mailing Address - Phone:360-645-3222
Mailing Address - Fax:360-645-2723
Practice Address - Street 1:250 FORT ST.
Practice Address - Street 2:
Practice Address - City:NEAH BAY
Practice Address - State:WA
Practice Address - Zip Code:98357
Practice Address - Country:US
Practice Address - Phone:360-645-3222
Practice Address - Fax:360-645-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center