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13051 Us Hwy 12, Ste 2 Packwood WA 98361-9835 | |
(360) 496-5112 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 13051 Us Hwy 12, Ste 2, Packwood, Washington |
Authorized Official Name and Position | Cheryl J Cornwell (CFO) |
Authorized Official Contact | 3604963647 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1138 Morton WA 98356-0019 Ph: (360) 496-5112 | 13051 Us Hwy 12, Ste 2 Packwood WA 98361-9835 Ph: (360) 496-5112 |
NPI Number | 1497466494 |
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Provider Enumeration Date | 12/09/2022 |
Last Update Date | 10/02/2024 |
Medicare PECOS PAC ID | 6002727385 |
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Medicare Enrollment ID | O20230302000668 |
Identifier | Type | State | Issuer |
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1497466494 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Lewis County Hospital District No 1 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 13051 Us Hway 12, Ste 2, Packwood, WA 98361 Phone: 360-496-3777 |