Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 461 G St, Forks, Washington |
Authorized Official Name and Position | David Schultz (PRESIDENT) |
Authorized Official Contact | 3607446505 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
461 G St Forks WA 98331-9025 Ph: (360) 374-6224 | 461 G St Forks WA 98331-9025 Ph: (360) 374-6224 |
NPI Number | 1255616579 |
---|---|
Provider Enumeration Date | 10/18/2011 |
Last Update Date | 07/13/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255616579 | NPI | - | NPPES |
2020155 | Medicaid | WA | |
287849 | Other | WA | LABOR AND INDUSTRIES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
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 | |