Provider Demographics
NPI:1902240070
Name:EASTERN SHOSHONE TRIBAL HEALTH
Entity Type:Organization
Organization Name:EASTERN SHOSHONE TRIBAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:307-332-6805
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:FORT WASHAKIE
Mailing Address - State:WY
Mailing Address - Zip Code:82514-0250
Mailing Address - Country:US
Mailing Address - Phone:307-332-6805
Mailing Address - Fax:307-332-0458
Practice Address - Street 1:15230 US HWY 287
Practice Address - Street 2:
Practice Address - City:FORT WASHAKIE
Practice Address - State:WY
Practice Address - Zip Code:82514-0250
Practice Address - Country:US
Practice Address - Phone:307-332-6805
Practice Address - Fax:307-332-0458
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN SHOSHONE TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-19
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health