Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 3801 Kern Way, Yakima, Washington |
Authorized Official Name and Position | Juan Carlos Olivares (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 5098656175 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 190 Toppenish WA 98948-0190 Ph: (509) 574-3221 | 3801 Kern Way Yakima WA 98902-6340 Ph: (509) 574-3221 |
NPI Number | 1801925003 |
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Provider Enumeration Date | 03/05/2007 |
Last Update Date | 02/12/2008 |
Medicare PECOS PAC ID | 4385541986 |
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Medicare Enrollment ID | O20201229001579 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801925003 | NPI | - | NPPES |
7033913 | Medicaid | WA | |
7093560 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Yakima Gastroenterology Associates, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3909 Creekside Loop, Suite 130, Yakima, WA 98902 Phone: 509-248-6616 Fax: 509-248-4983 | |