| |
390 Founders Way Forks WA 98331-9062 | |
(360) 374-6271 | |
(360) 374-9781 |
Full Name | |
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Speciality | Clinic/Center |
Location | 390 Founders Way, Forks, Washington |
Authorized Official Name and Position | Heidi Anderson (CEO) |
Authorized Official Contact | 3603746271 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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390 Founders Way Forks WA 98331 Ph: (360) 374-6271 | 390 Founders Way Forks WA 98331-9062 Ph: (360) 374-6271 |
NPI Number | 1285683052 |
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Provider Enumeration Date | 05/09/2006 |
Last Update Date | 01/11/2022 |
Medicare PECOS PAC ID | 1557256468 |
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Medicare Enrollment ID | O20090522000376 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285683052 | NPI | - | NPPES |
7113442 | Medicaid | WA | |
7047459 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | H-054 (Washington) | Primary |
Chinook Pharmacy Clinical Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11 S Forks Ave Ste A, Forks, WA 98331 Phone: 360-374-2294 Fax: 360-374-5057 | |