| New Health Loon Lake Medical | |
|
3994 Colville Rd Loon Lake WA 99148-9789 | |
| (509) 233-8412 | |
| (509) 233-2864 |
| Full Name | New Health Loon Lake Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 3994 Colville Rd, Loon Lake, Washington |
| Authorized Official Name and Position | Donna Poe (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 5099356001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Health Loon Lake Medical Po Box 808 Chewelah WA 99109-0808 Ph: (509) 935-6001 | New Health Loon Lake Medical 3994 Colville Rd Loon Lake WA 99148-9789 Ph: (509) 233-8412 |
| NPI Number | 1295799195 |
|---|---|
| Provider Enumeration Date | 04/17/2006 |
| Last Update Date | 07/18/2023 |
| Medicare PECOS PAC ID | 1951202373 |
|---|---|
| Medicare Enrollment ID | O20120315000490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295799195 | NPI | - | NPPES |
| 7034440 | Medicaid | WA | |
| 80300 | Other | WA | LABOR AND INDUSTRIES ID |
| 7034077 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | J600317870 (Washington) | Primary |