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1420 Ahtanum Ridge Dr Union Gap WA 98903-1839 | |
(509) 454-7700 | |
(509) 454-7710 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1420 Ahtanum Ridge Dr, Union Gap, Washington |
Authorized Official Name and Position | Mathew Mathiesen (CEO) |
Authorized Official Contact | 5098371364 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 719 Sunnyside WA 98944-0719 Ph: (509) 454-7700 | 1420 Ahtanum Ridge Dr Union Gap WA 98903-1839 Ph: (509) 454-7700 |
NPI Number | 1013492784 |
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Provider Enumeration Date | 09/28/2018 |
Last Update Date | 10/03/2024 |
Medicare PECOS PAC ID | 4082980065 |
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Medicare Enrollment ID | O20190102003109 |
Identifier | Type | State | Issuer |
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1013492784 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |