Basic Information
| Provider Information | |||||||||
| NPI: | 1881690758 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNITED INDIAN HEALTH SERVICES, INC. | ||||||||
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| OtherOrganizationName: | HOP'-EW PUEL KLAMATH HEALTH CENTER | ||||||||
| 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: | 241 SALMON AVE | ||||||||
| Address2: | |||||||||
| City: | KLAMATH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074822181 | ||||||||
| FaxNumber: | 7074823655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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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: | 07/08/2022 | ||||||||
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 | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.