| |
237 Professional Way Shelton WA 98584-4404 | |
(360) 426-2500 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 237 Professional Way, Shelton, Washington |
Authorized Official Name and Position | Eric Moll (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 3604269554 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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237 Professional Way Shelton WA 98584-4404 Ph: (360) 426-2500 | 237 Professional Way Shelton WA 98584-4404 Ph: (360) 426-2500 |
NPI Number | 1205264561 |
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Provider Enumeration Date | 10/24/2013 |
Last Update Date | 09/18/2014 |
Medicare PECOS PAC ID | 0345139275 |
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Medicare Enrollment ID | O20131219001411 |
Identifier | Type | State | Issuer |
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1205264561 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 232002969 (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 |