Port Gamble S'klallam Tribe

NPI #1760428650 in Kingston, Washington

Provider Information

NPI Number
1760428650
Entity Type
Organization
Organization Name
Port Gamble S'klallam Tribe
Primary Specialty
Clinic/Center - Federally Qualified Health Center (FQHC)
Enumeration Date
Jun 21, 2006
Last Updated
Jan 7, 2011

Practice Location

Address
32014 LITTLE BOSTON RD NE
ZIP Code
98346-9734
Phone
(360) 297-9601

Authorized Official

Name
DALLAS I DEGUIRE
Title
ADMINISTRATIVE DIRECTOR
Phone
(360) 297-9601

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Federally Qualified Health Center (FQHC)Federally Qualified Health Center (FQHC)

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