| Mansfield Family Medicine | |
|
22 West Highway 28 Soap Lake WA 98851 | |
| (509) 888-9606 | |
| (509) 246-8001 |
| Full Name | Mansfield Family Medicine |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 22 West Highway 28, Soap Lake, Washington |
| Authorized Official Name and Position | Eldon Lester Leinweber (CEO, MANAGER) |
| Authorized Official Contact | 5098817503 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mansfield Family Medicine Po Box 1050 Soap Lake WA 98851-1050 Ph: (509) 888-9606 | Mansfield Family Medicine 22 West Highway 28 Soap Lake WA 98851 Ph: (509) 888-9606 |
| NPI Number | 1790021822 |
|---|---|
| Provider Enumeration Date | 12/18/2012 |
| Last Update Date | 05/24/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790021822 | NPI | - | NPPES |
| 8418451 | Medicaid | WA | |
| Q59925 | Other | WA | UPIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | PA10004217 (Washington) | Primary |
Soap Lake Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 127 2nd Ave Sw, Soap Lake, WA 98851 Phone: 509-246-0540 Fax: 509-246-0358 |