SHOSHONE TRIBE (NPI# 1790824530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790824530 |
| Entity Type | Organization |
| Organization Name | SHOSHONE TRIBE |
| Other Organization Name | WIND RIVER DIALYSIS CENTER |
| Practice Address |
11 Shipton Lane Fort Washakie WY 82514 |
| Mailing Address |
Po Box 998 Fort Washakie WY 82514-0998 |
| Practice Telephone | 3073322998 |
| Practice Fax Number | 3073324955 |
| Mailing Telephone | 3073322998 |
| Mailing Fax Number | 3073324955 |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2008-04-24 |
| Authorized Official Name | MS. DIANE GARCIA (CEO, NURSE MANAGER) |
| Authorized Official Telephone | 3073322998 |
| Authorized Official Credential | RN, BSN, CNN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
07-177 | WY | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Wind River Dialysis Center | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SHOSHONE TRIBE | 111 North Rd, Mc Dermitt, NV 89421 |
| Street Address |
11 SHIPTON LANE |
| City | FORT WASHAKIE |
| State | WY |
| Zip Code | 82514 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619527819 | Melissa Rose Pine | Registered Nurse | 29 Blackcole Road, Fort Washakie, WY 82514 | 2019-09-19 |
| 1982116794 | Madonna Lee Kienlen | Peer Specialist | 215 Ethete Road, Ft. Washakie, WY 82514 | 2017-11-02 |
| 1649789025 | Rebecca Charlene Willis | Technician, Other | Fort Washakie Healt Center Lab Ihs 29 Black Coal Drive, Fort Washakie, WY 82514 | 2017-09-28 |
| 1033553185 | Pauline Elizabeth Powers-peprah | Family Medicine | 29 Black Cole, Fort Washakie, WY 82514 | 2013-04-19 |
| 1528319373 | Amanda L Schultz | Licensed Practical Nurse | 110 Sharpnose Road, Fort Washakie, WY 82514 | 2012-09-19 |
| 1770898140 | Kelly Lynne Pretty Weasel | Clinic/Center | 29 Blackcole Dr, Fort Washakie, WY 82514 | 2010-08-10 |
| 1285950170 | Debra Kay Waters | Technician, Pathology | Black Coal Rd. Bldg. 29, Ft. Washakie, WY 82514 | 2010-04-16 |
| 1881919751 | Shoshone & Arapaho Tribal Substance Abuse Court | Clinic/Center | 215 Ethete Rd, Fort Washakie, WY 82514 | 2010-04-02 |
| 1770814253 | Christopher G Nelson | Spec/Tech, Pathology | 29 Black Coal Rd, Ft. Washakie, WY 82514 | 2010-01-22 |
| 1922339449 | Nina Williams | Spec/Tech, Pathology | Black Coal Rd Bldg 29, Ft Washakie, WY 82514 | 2010-01-22 |
| Find all providers in zip 82514 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306392261 | Usrc Casper, LLC | Clinic/Center | 1300 Venture Way, Suite 100, Casper, WY 82609-4353 | 2016-08-31 |
| 1952413759 | Bio-medical Applications of Wyoming LLC | Clinic/Center | 1739 Meadowland Drive, Cheyenne, WY 82009-5249 | 2006-08-31 |
| 1255304051 | Evanston Hospital Corporation | Clinic/Center | 112 Yellow Creek Rd, Evanston, WY 82930-9266 | 2006-02-10 |
| 1508837865 | Wyoming Kidney Center, LLC | Clinic/Center | 1141 Wilkins Cir, Casper, WY 82601-1332 | 2006-01-26 |
| 1730562372 | Watt Dialysis Center LLC | Clinic/Center | 1401 W 5th St, Sheridan, WY 82801-2705 | 2015-07-01 |
| 1669818969 | Big Horn Basin Regional Dialysis Center LLC | Clinic/Center | 424 Yellowstone Ave, Suite 150, Cody, WY 82414-9309 | 2013-05-14 |
| 1609932383 | Billings Clinic | Clinic/Center | 1401 W 5th St, Sheridan, WY 82801-2705 | 2006-12-28 |
| 1295815744 | West Park Hospital District | Clinic/Center | 707 Sheridan Ave, Cody, WY 82414-3409 | 2006-10-17 |
| 1144313255 | Campbell County Hospital District | Clinic/Center | 501 S Burma Ave, Gillette, WY 82716-3426 | 2006-10-02 |
| City | FORT WASHAKIE |
| Zip Code | 82514 |
Please comment or provide details below to improve the information on SHOSHONE TRIBE.
| 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.