| Organization Name: | INDIAN HEALTH SERVICE |
| NPI Number: | 1770518532 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GINA ANN RAMIREZ (MEDICAL RECORDS SUPERVISOR) |
| Mailing Address: | Bldg. 29 Black Coal Drive Fort Washakie |
| State: | WY US |
| Postal Code: | 825140128 |
| Phone Number: | 3073327300 |
| Fax Number: | 3073323931 |
| NPI Enumeration Date: | 07/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 6740A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |