Provider Demographics
NPI:1912591561
Name:TUNICA BILOXI TRIBE OF LOUISIANA TRIBAL OFFICE
Entity Type:Organization
Organization Name:TUNICA BILOXI TRIBE OF LOUISIANA TRIBAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:MITCHELLE
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-359-3659
Mailing Address - Street 1:171 MELANCON RD
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-3065
Mailing Address - Country:US
Mailing Address - Phone:318-253-9767
Mailing Address - Fax:
Practice Address - Street 1:171 MELANCON RD
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-3065
Practice Address - Country:US
Practice Address - Phone:318-253-9767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center