Provider Demographics
NPI:1548307929
Name:YAKAMA INDIAN HEALTH CENTER
Entity type:Organization
Organization Name:YAKAMA INDIAN HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-865-2102
Mailing Address - Street 1:401 BUSTER RD
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-9792
Mailing Address - Country:US
Mailing Address - Phone:509-865-2102
Mailing Address - Fax:509-865-4986
Practice Address - Street 1:401 BUSTER RD
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-9792
Practice Address - Country:US
Practice Address - Phone:509-865-2102
Practice Address - Fax:509-865-4986
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YAKAMA INDIAN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7100506Medicaid
WA21940OtherLAB.&INDSTRY.MED#
WA4926311OtherNATL.ASSOC.BD.PHARM.
WA51239OtherLABOR & INDUSTRY RX
WA51239OtherLABOR & INDUSTRY RX
WA4926311OtherNATL.ASSOC.BD.PHARM.