Organization Name: | PHS INDIAN HEALTH SERVICE |
NPI Number: | 1922320910 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TARA ROBINSON (CREDENTIALING COORDINATOR) |
Mailing Address: | 29 Black Coal Drive Fort Washakie |
State: | WY US |
Postal Code: | 825140128 |
Phone Number: | 3073327300 |
Fax Number: | 3073325753 |
NPI Enumeration Date: | 02/18/2010 |
NPI Last Update Date: | 02/18/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP0904X |
License Number: | 19751 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Public Health, Federal |
Taxonomy Definition: |