Full Name | |
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Speciality | Clinic/Center |
Location | 620 W 1st St, Wapato, Washington |
Authorized Official Name and Position | Juan Carlos Olivares (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 5098656175 |
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 190 Toppenish WA 98948-0190 Ph: (509) 865-6175 | 620 W 1st St Wapato WA 98951-1108 Ph: (509) 877-4111 |
NPI Number | 1740459833 |
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Provider Enumeration Date | 02/22/2008 |
Last Update Date | 02/22/2008 |
Medicare PECOS PAC ID | 4385541986 |
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Medicare Enrollment ID | O20201026003204 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740459833 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |