Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 461 G St, Forks, Washington |
Authorized Official Name and Position | Carie Micheau (COMPLIANCE OFFICER) |
Authorized Official Contact | 3603746271 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
530 Bogachiel Way Forks WA 98331-9120 Ph: (360) 374-6271 | 461 G St Forks WA 98331-9025 Ph: (360) 374-6271 |
NPI Number | 1285290338 |
---|---|
Provider Enumeration Date | 05/14/2019 |
Last Update Date | 08/09/2019 |
Medicare PECOS PAC ID | 1557256468 |
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Medicare Enrollment ID | O20190624000999 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285290338 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | 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 | |