Provider Demographics
NPI:1811091911
Name:DHHS IHS COLVILLE SERVICE UNIT
Entity type:Organization
Organization Name:DHHS IHS COLVILLE SERVICE UNIT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MISIASZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-634-2900
Mailing Address - Street 1:19 LAKES ST
Mailing Address - Street 2:
Mailing Address - City:NESPELEM
Mailing Address - State:WA
Mailing Address - Zip Code:99155-0071
Mailing Address - Country:US
Mailing Address - Phone:509-634-2900
Mailing Address - Fax:509-634-2990
Practice Address - Street 1:19 LAKES ST
Practice Address - Street 2:
Practice Address - City:NESPELEM
Practice Address - State:WA
Practice Address - Zip Code:99155-0071
Practice Address - Country:US
Practice Address - Phone:509-634-2900
Practice Address - Fax:509-634-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7100100Medicaid
WA5400189Medicaid
WA7139660Medicaid
WA7139660Medicaid