Lacey Medical Clinic Ps | |
5602 Ruddell Rd Se Lacey WA 98503 | |
(360) 438-0394 | |
(360) 493-0824 |
Full Name | Lacey Medical Clinic Ps |
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Speciality | Family Medicine |
Location | 5602 Ruddell Rd Se, Lacey, Washington |
Authorized Official Name and Position | Ronald Charles Krauss (PRESIDENT) |
Authorized Official Contact | 3604380394 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lacey Medical Clinic Ps 5602 Ruddell Rd Se Lacey WA 98503 Ph: (360) 438-0394 | Lacey Medical Clinic Ps 5602 Ruddell Rd Se Lacey WA 98503 Ph: (360) 438-0394 |
NPI Number | 1558464974 |
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Provider Enumeration Date | 09/07/2006 |
Last Update Date | 06/23/2014 |
Medicare PECOS PAC ID | 2769379882 |
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Medicare Enrollment ID | O20040305000129 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558464974 | NPI | - | NPPES |
7069750 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Ronald C Krauss |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1235105719 PECOS PAC ID: 5092603704 Enrollment ID: I20100120000640 |
Provider Name | Will W Leighty |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1811285026 PECOS PAC ID: 9234354366 Enrollment ID: I20140724000585 |
Provider Name | Diane E Ames |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1932653052 PECOS PAC ID: 3870881733 Enrollment ID: I20161007001186 |
Provider Name | Lisa A Duran |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1740824960 PECOS PAC ID: 5698105005 Enrollment ID: I20200427002696 |
Provider Name | Laura Brownsmith |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518545102 PECOS PAC ID: 9032508155 Enrollment ID: I20211111000824 |
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