| |
4254 Jackson Hwy Chehalis WA 98532-8424 | |
(360) 996-6603 | |
(360) 996-6604 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4254 Jackson Hwy, Chehalis, Washington |
Authorized Official Name and Position | Gaelon B Spradley (CEO) |
Authorized Official Contact | 3603309555 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2690 Ne Kresky Ave Chehalis WA 98532-2412 Ph: (360) 330-9595 | 4254 Jackson Hwy Chehalis WA 98532-8424 Ph: (360) 996-6603 |
NPI Number | 1326729864 |
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Provider Enumeration Date | 07/27/2023 |
Last Update Date | 01/24/2024 |
Medicare PECOS PAC ID | 6002803749 |
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Medicare Enrollment ID | O20231026003628 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326729864 | NPI | - | NPPES |
7126972 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Marys Corner Medical Clinic Inc. Ps Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4254 Jackson Highway, Chehalis, WA 98532 Phone: 360-262-3966 Fax: 360-262-3967 | |
Wooten Primary Care, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 123 S Market Blvd, Chehalis, WA 98532 Phone: 360-748-9700 Fax: 360-748-9725 | |
Apnec Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 192 Carroll Rd, Chehalis, WA 98532 Phone: 253-951-6438 | |