Basic Information
| Provider Information | |||||||||
| NPI: | 1821440371 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNITED INDIAN HEALTH SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | XAA-WAN'-K'WVT CLINIC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 WEEOT WAY | ||||||||
| Address2: | |||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955214734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078255000 | ||||||||
| FaxNumber: | 7078256747 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 N INDIAN RD | ||||||||
| Address2: | |||||||||
| City: | SMITH RIVER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955679509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074870215 | ||||||||
| FaxNumber: | 7074873003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2016 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | CECIL | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7078254065 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 261QD0000X | N | Ambulatory Health Care Facilities | Clinic/Center | Dental | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QC1500X | EXEMPT | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.