| |
702 Broadway Suite 102 Tacoma WA 98402-3735 | |
(253) 473-7586 | |
(253) 590-0211 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 702 Broadway, Tacoma, Washington |
Authorized Official Name and Position | Jeremy Matheson Wekell (ADMINISTRATOR) |
Authorized Official Contact | 2534737586 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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702 Broadway Suite 102 Tacoma WA 98402-3735 Ph: (253) 473-7586 | 702 Broadway Suite 102 Tacoma WA 98402-3735 Ph: (253) 473-7586 |
NPI Number | 1346547064 |
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Provider Enumeration Date | 02/15/2011 |
Last Update Date | 02/15/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346547064 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 27145100 (Washington) | Primary |
291U00000X | Clinical Medical Laboratory | 27145100 (Washington) | Secondary |
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