| Quinault Indian Nation | |
|
1505 Kla-ook-wa Drive Taholah WA 98587 | |
| (360) 276-4405 | |
| (360) 276-4602 |
| Full Name | Quinault Indian Nation |
|---|---|
| Speciality | Clinic/Center |
| Location | 1505 Kla-ook-wa Drive, Taholah, Washington |
| Authorized Official Name and Position | Mariah Yvonne Ralston (OFFICE MANAGER) |
| Authorized Official Contact | 3602764405 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Quinault Indian Nation Po Box 219 1505 Kla-ook-wa Dr. Taholah WA 98587 Ph: (360) 276-4405 | Quinault Indian Nation 1505 Kla-ook-wa Drive Taholah WA 98587 Ph: (360) 276-4405 |
| NPI Number | 1093888547 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 05/27/2008 |
| Medicare PECOS PAC ID | 0446147086 |
|---|---|
| Medicare Enrollment ID | O20040301000160 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093888547 | NPI | - | NPPES |
| 7082191 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Julie M Buck |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346280484 PECOS PAC ID: 9335134519 Enrollment ID: I20040922000133 |
| Provider Name | Elizabeth Swift |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114233731 PECOS PAC ID: 6901090901 Enrollment ID: I20101103001295 |
| Provider Name | Dale Austin Armstrong |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871586578 PECOS PAC ID: 0941214548 Enrollment ID: I20230628001300 |
| Provider Name | Kristen A Hodsdon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821007600 PECOS PAC ID: 5294875621 Enrollment ID: I20230630002459 |
| Provider Name | Julia Elizabeth Mackaronis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497123855 PECOS PAC ID: 0749649465 Enrollment ID: I20230706002331 |
| Provider Name | Samantha Capoeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184480741 PECOS PAC ID: 1850829482 Enrollment ID: I20250110001059 |