| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 5 Kettle River Rd, Curlew, Washington |
| Authorized Official Name and Position | Gary Robertson (CHIEF EXECUTIVE OFFI) |
| Authorized Official Contact | 5094453333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
36 Klondike Rd Republic WA 99166-9701 Ph: (509) 779-4049 | 5 Kettle River Rd Curlew WA 99118 Ph: (509) 779-4049 |
| NPI Number | 1205988219 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 05/06/2024 |
| Medicare PECOS PAC ID | 0446148761 |
|---|---|
| Medicare Enrollment ID | O20081027000299 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205988219 | NPI | - | NPPES |
| 7033210 | Medicaid | WA | |
| 7119134 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |