ST REGIS MOHAWK TRIBE NPI 1457344558

NPI Information

NPI: 1457344558
Provider Name: ST REGIS MOHAWK TRIBE

Doing Business As: ST REGIS MOHAWK HEALTH SERVICES

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 33D1020880

Address:
412 STATE ROUTE 37
AKWESASNE, NY
ZIP 13655
Phone: (518) 358-3141
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ST REGIS MOHAWK TRIBE is a federally qualified health center (fqhc) clinic center in Akwesasne, NY. ST REGIS MOHAWK TRIBE NPI is 1457344558. The provider is registered as an organization entity type.
The provider Is Doing Business As St Regis Mohawk Health Services.

The provider's business location address is:

412 STATE ROUTE 37
AKWESASNE, NY
ZIP 13655-109
Phone: (518) 358-3141
Fax: (518) 358-2797

The provider's authorized official is Barbara Lazore .
The authorized official title is Tribal Chief and has the following contact phone number (518) 358-3141.

The CLIA number assigned to this NPI record is 33D1020880 - comp. outpatient rehab facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/24/2005 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	1653200R	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00651785	MEDICAID	NEW YORK
2	01178234	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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