Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 100 S Scott, Newport, Washington |
Authorized Official Name and Position | Tom Wilbur (CEO) |
Authorized Official Contact | 5094472441 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
714 W Pine St Newport WA 99156-9046 Ph: (509) 447-2441 | 100 S Scott Newport WA 99156 Ph: (509) 447-2441 |
NPI Number | 1124159900 |
---|---|
Provider Enumeration Date | 03/07/2007 |
Last Update Date | 06/25/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124159900 | NPI | - | NPPES |
7113962 | Medicaid | WA | |
805262500 | Medicaid | ID | |
7109184 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 264000780-001-0002 (Washington) | Primary |