| L A Professional Service Corp. | |
|
804 Callahan Dr # A Bremerton WA 98310-3307 | |
| (360) 377-9744 | |
| (360) 377-2341 |
| Full Name | L A Professional Service Corp. |
|---|---|
| Speciality | Family Medicine |
| Location | 804 Callahan Dr # A, Bremerton, Washington |
| Authorized Official Name and Position | Terrilynn Nicklin Griswold (BILLING MANAGER) |
| Authorized Official Contact | 3604343009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| L A Professional Service Corp. 804 Callahan Dr # A Bremerton WA 98310-3307 Ph: (360) 377-9744 | L A Professional Service Corp. 804 Callahan Dr # A Bremerton WA 98310-3307 Ph: (360) 377-9744 |
| NPI Number | 1760551410 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760551410 | NPI | - | NPPES |
| AF1655 | Other | WA | REGENCE |
| 1048636 | Medicaid | WA | |
| 0075138 | Other | WA | L&I |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 002495 (Washington) | Primary |
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