Provider Demographics
NPI:1932539061
Name:EMPIRE WASHITAW DE DUGDAHMOUNDYAH NATION OF MUURS
Entity Type:Organization
Organization Name:EMPIRE WASHITAW DE DUGDAHMOUNDYAH NATION OF MUURS
Other - Org Name:PAMUNKEY NATION INDIAN TRIBE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CROWN PRINCE /CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:EMPEROR
Authorized Official - Middle Name:EL BEY
Authorized Official - Last Name:BAGBY BIGBAY PAMUNKEY
Authorized Official - Suffix:
Authorized Official - Credentials:TRIBAL PHD ,AHI PAA,
Authorized Official - Phone:609-880-5322
Mailing Address - Street 1:EMBASSY OF THE EMPIRE WASHITAW DE DUGDAHMOUNDYAH 215 93
Mailing Address - Street 2:PALIS 1211
Mailing Address - City:GENEVA
Mailing Address - State:GENEVA
Mailing Address - Zip Code:10
Mailing Address - Country:CH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 ASSUNPINK VILLAGE
Practice Address - Street 2:MILLHAM TOWNSHIP
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609
Practice Address - Country:US
Practice Address - Phone:804-496-1597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POWHATAN INDIANS OF THE DELEWARE VALLEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-27
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 251B00000X, 251K00000X, 251S00000X, 291U00000X, 293D00000X, 3245S0500X, 332800000X, 343900000X, 347C00000X
NJ26NH14573800302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological Laboratory
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI455788656OtherKEMETIC SEBA CONSULTANT
NJ6513412732Medicare PIN