| |
247 Professional Way Shelton WA 98584 | |
(360) 426-3102 | |
(360) 426-9866 |
Full Name | |
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Speciality | Clinic/Center |
Location | 247 Professional Way, Shelton, Washington |
Authorized Official Name and Position | Eric Moll (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 3604279554 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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247 Professional Way Shelton WA 98584 Ph: (360) 426-3102 | 247 Professional Way Shelton WA 98584 Ph: (360) 426-3102 |
NPI Number | 1619180213 |
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Provider Enumeration Date | 05/08/2007 |
Last Update Date | 03/24/2020 |
Medicare PECOS PAC ID | 0345139275 |
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Medicare Enrollment ID | O20130325000347 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619180213 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Washington) | Primary |
Olympic Physicians, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 221 Professional Way, Shelton, WA 98584 Phone: 360-426-2500 Fax: 360-462-2500 | |
Northwest Indian Treatment Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Se Whitener Rd, Shelton, WA 98584 Phone: 360-470-1474 |