Full Name | |
---|---|
Speciality | Surgery |
Location | 521 Adams Avenue, Morton, Washington |
Authorized Official Name and Position | Richard Boggess (CEO) |
Authorized Official Contact | 3604963647 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1138 Morton WA 98356-0019 Ph: (360) 496-3504 | 521 Adams Avenue Morton WA 98365 Ph: (360) 496-3517 |
NPI Number | 1386679777 |
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Provider Enumeration Date | 07/12/2006 |
Last Update Date | 08/20/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386679777 | NPI | - | NPPES |
7121064 | Medicaid | WA | |
154384 | Other | WA | LABOR & INDUSTRIES |