Highland Clinic | |
915 Wisconsin Avenue Tieton WA 98947 | |
(509) 673-0044 | |
(509) 673-0054 |
Full Name | Highland Clinic |
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Speciality | Clinic/Center |
Location | 915 Wisconsin Avenue, Tieton, Washington |
Authorized Official Name and Position | Angela Gonzalez (CEO) |
Authorized Official Contact | 5094946700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Highland Clinic 501 S 5th Ave Yakima WA 98902-3550 Ph: (509) 494-6700 | Highland Clinic 915 Wisconsin Avenue Tieton WA 98947 Ph: (509) 673-0044 |
NPI Number | 1700255874 |
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Provider Enumeration Date | 09/18/2015 |
Last Update Date | 07/29/2020 |
Medicare PECOS PAC ID | 4183536931 |
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Medicare Enrollment ID | O20151201002152 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700255874 | NPI | - | NPPES |
0031820 | Other | WA | LABOR AND INDUSTRIES |
901005 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |