| |
1268 E Main St Suite 1 Auburn WA 98002-5748 | |
(253) 735-1991 | |
(253) 735-8837 |
Full Name | |
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Speciality | Clinic/center |
Location | 1268 E Main St, Auburn, Washington |
Authorized Official Name and Position | John T Blackwelder (PRESIDENT) |
Authorized Official Contact | 2537351991 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1268 E Main St Suite 1 Auburn WA 98002-5748 Ph: (253) 735-1991 | 1268 E Main St Suite 1 Auburn WA 98002-5748 Ph: (253) 735-1991 |
NPI Number | 1811005861 |
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Provider Enumeration Date | 08/29/2006 |
Last Update Date | 07/17/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811005861 | NPI | - | NPPES |
7117252 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 602300908 (Washington) | Primary |
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