| Capital Family Care And Sports Medicine | |
|
410-a Black Hills Lane Sw Olympia WA 98502-2300 | |
| (360) 754-2300 | |
| (360) 754-1044 |
| Full Name | Capital Family Care And Sports Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 410-a Black Hills Lane Sw, Olympia, Washington |
| Authorized Official Name and Position | Robert Roscoe Nooney (OWNER/PHYSICIAN) |
| Authorized Official Contact | 3607542300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Capital Family Care And Sports Medicine Po Box 11392 Olympia WA 98508-1392 Ph: (360) 754-2300 | Capital Family Care And Sports Medicine 410-a Black Hills Lane Sw Olympia WA 98502-2300 Ph: (360) 754-2300 |
| NPI Number | 1700031317 |
|---|---|
| Provider Enumeration Date | 11/24/2008 |
| Last Update Date | 02/19/2009 |
| Medicare PECOS PAC ID | 0648337584 |
|---|---|
| Medicare Enrollment ID | O20090320000493 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700031317 | NPI | - | NPPES |
| 1083021 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OPO00001277 (Washington) | Primary |
| Provider Name | Robert R Nooney |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1558389544 PECOS PAC ID: 5698844306 Enrollment ID: I20080521000504 |
| Provider Name | Margaret M Hennessey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225328248 PECOS PAC ID: 6204006422 Enrollment ID: I20110825000758 |
| Provider Name | Jacqueline Little |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1831587252 PECOS PAC ID: 6608122015 Enrollment ID: I20180627001313 |
| Provider Name | Tanele M Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710634464 PECOS PAC ID: 7911385109 Enrollment ID: I20220531000933 |
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