Full Name | |
---|---|
Speciality | Family Medicine |
Location | 461 G St, Forks, Washington |
Authorized Official Name and Position | Stephen H Kriebel (PRESIDENT) |
Authorized Official Contact | 3603746224 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 455 Forks WA 98331-0455 Ph: (360) 374-6224 | 461 G St Forks WA 98331-9025 Ph: (360) 374-6224 |
NPI Number | 1245375518 |
---|---|
Provider Enumeration Date | 02/21/2007 |
Last Update Date | 04/20/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245375518 | NPI | - | NPPES |
7020654 | Medicaid | WA | |
1770509242 | Other | WA | LAURA NPI |
7058829 | Medicaid | WA | |
1659374114 | Other | WA | DR K NPI # |
0048001 | Other | WA | WA ST L&I |
8156200 | Medicaid | WA | |
KR9095 | Other | WA | REGENCE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 13422 (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 | |