| |
915 Auburn Way N Ste B Auburn WA 98002-4117 | |
(425) 277-1311 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 915 Auburn Way N Ste B, Auburn, Washington |
Authorized Official Name and Position | Brittany Aydelott (ENROLLMENT SPECIALIST) |
Authorized Official Contact | 4254246329 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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955 Powell Ave Sw Renton WA 98057-2908 Ph: (425) 277-1311 | 915 Auburn Way N Ste B Auburn WA 98002-4117 Ph: (425) 277-1311 |
NPI Number | 1053172635 |
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Provider Enumeration Date | 01/19/2024 |
Last Update Date | 04/03/2024 |
Medicare PECOS PAC ID | 9335042886 |
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Medicare Enrollment ID | O20240627000393 |
Identifier | Type | State | Issuer |
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1053172635 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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