Basic Information
| Provider Information | |||||||||
| NPI: | 1578890554 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KARUK TRIBE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1016 | ||||||||
| Address2: | |||||||||
| City: | HAPPY CAMP | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960391016 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 325 ASIP ROAD | ||||||||
| Address2: | |||||||||
| City: | ORLEANS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306273452 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2009 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | ATTEBERY | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 5304931600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 19343 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.