SHOALWATER BAY INDIAN TRIBE (NPI# 1003028952) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003028952 |
| Entity Type | Organization |
| Organization Name | SHOALWATER BAY INDIAN TRIBE |
| Other Organization Name | SHOALWATER BAY TRIBAL CLINIC |
| Practice Address |
2373 Old Tokeland Rd Tokeland WA 98590 |
| Mailing Address |
Po Box 500 Tokeland WA 98590-0500 |
| Practice Telephone | 3602678103 |
| Practice Fax Number | 3602671437 |
| Mailing Telephone | 3602670119 |
| Mailing Fax Number | 3602670417 |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. CAROL JOHNSON (TRIBAL ADMINISTRATOR) |
| Authorized Official Telephone | 3602676766 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Shoalwater Bay Tribal Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316159056 | Shoalwater Bay Indian Tribe | Clinic/Center | 2373 Old Tokeland Rd, Tokeland, WA 98590 | 2007-05-04 |
| 1447462700 | Shoalwater Bay Indian Tribe | Clinic/Center | 2373 Old Tokeland Rd, Tokeland, WA 98590 | 2007-05-07 |
| 1104038926 | Shoalwater Bay Indian Tribe | Community/Behavioral Health | 2373 Old Tokeland Rd, Tokeland, WA 98590 | 2007-05-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SHOALWATER BAY INDIAN TRIBE | 2373 Tokeland Rd, Tokeland, WA 98590-9729 |
| Street Address |
2373 OLD TOKELAND RD |
| City | TOKELAND |
| State | WA |
| Zip Code | 98590 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316159056 | Shoalwater Bay Indian Tribe | Clinic/Center | 2373 Old Tokeland Rd, Tokeland, WA 98590 | 2007-05-04 |
| 1447462700 | Shoalwater Bay Indian Tribe | Clinic/Center | 2373 Old Tokeland Rd, Tokeland, WA 98590 | 2007-05-07 |
| 1689886475 | Pamela J Korzeniowski | Physician Assistant | 2373 Old Tokeland Rd, Tokeland, WA 98590 | 2007-05-04 |
| 1699987487 | Jeanne Paul | Marriage & Family Therapist | 2373 Old Tokeland Rd, Tokeland, WA 98590 | 2007-05-04 |
| 1679785463 | Gregory Dale Cebulla | Dentist | 2373 Old Tokeland Rd, Tokeland, WA 98590 | 2007-05-04 |
| 1104038926 | Shoalwater Bay Indian Tribe | Community/Behavioral Health | 2373 Old Tokeland Rd, Tokeland, WA 98590 | 2007-05-04 |
| 1063624740 | Shoalwater Bay Tribe | Clinic/Center | 2373 Old Tokeland Rd, Tokeland, WA 98590 | 2007-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750618302 | F. Scott Powell | Chiropractor | 2373 Old Tokeland Rd., Bldg. E, Tokeland, WA 98590 | 2009-11-03 |
| 1679723373 | Sherwin Rex Shinn | Dentist | 2373 Old Tokeland Road, Tokeland, WA 98590 | 2008-09-30 |
| 1831382324 | Shoalwater Bay Pharmacy | Pharmacy | 2373 Tokeland Road, Building E, Suite 145, Tokeland, WA 98590 | 2007-08-20 |
| 1497840151 | Kelley Rae Birdeau | Dentist | 2373 Tokeland Rd, Bldg #e, Tokeland, WA 98590 | 2006-10-04 |
| 1417193749 | Laura A Hamilton | Counselor | 2373 Old Tokeland Road, Bldg E, Tokeland, WA 98590 | 2008-12-16 |
| 1649567363 | Shoalwater Bay Wellness Center | Clinic/Center | 2373 Tokeland Road Building. E, Tokeland, WA 98590-0500 | 2011-07-01 |
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932700671 | K.lee, Dds, Pllc. | Clinic/Center | 20709 Mountain Hwy E # 102, Spanaway, WA 98387-8580 | 2020-11-06 |
| 1346841376 | Ralf F. Schuler, Dr. Med. Dent., Msd,pllc | Clinic/Center | 205 W Fairhaven Ave Ste C, Burlington, WA 98233-1062 | 2020-11-05 |
| 1356942684 | Healthy Smiles Northwest | Clinic/Center | 11808 18th St Se, Lake Stevens, WA 98258-2046 | 2020-11-03 |
| 1306446240 | Christine A Woodward, Dds, Pllc | Clinic/Center | 45860 Main St, Concrete, WA 98237 | 2020-10-29 |
| 1215535695 | Ellingsen Henneberg Pllc | Clinic/Center | 2607 S Southeast Blvd Ste B210, Spokane, WA 99223-7614 | 2020-10-16 |
| 1174121792 | Evolve Dental LLC | Clinic/Center | 4410 194th St Sw Ste A, Lynnwood, WA 98036-5598 | 2020-10-15 |
| 1326646035 | Natasha Habib Dds Ps | Clinic/Center | 1025 153rd St Se Ste 103, Mill Creek, WA 98012-4051 | 2020-10-14 |
| 1386241636 | Mellissa Ilgen, Dds, Pllc | Clinic/Center | 26114 Illinois Ave Ne, Kingston, WA 98346-7674 | 2020-10-08 |
| 1417554932 | Young, Yeung, Lee, Hockin, P.s | Clinic/Center | 2207 2nd Ave, Seattle, WA 98121-2016 | 2020-10-07 |
| 1164039731 | Consolidated Dental Three | Clinic/Center | 19221 108th Ave Se Ste 2, Renton, WA 98055-7369 | 2020-09-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.