| Mobile Medical Clinic Chess Inc | |
|
922 S Cowley St Suite 6 Spokane WA 99202-1263 | |
| (509) 220-3048 | |
| (509) 279-0286 |
| Full Name | Mobile Medical Clinic Chess Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 922 S Cowley St, Spokane, Washington |
| Authorized Official Name and Position | Tawny B Miles (VICE PRESIDENT/ADMIN DIRECTOR) |
| Authorized Official Contact | 5092203048 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mobile Medical Clinic Chess Inc 922 S Cowley St Suite 6 Spokane WA 99202-1263 Ph: (509) 220-3048 | Mobile Medical Clinic Chess Inc 922 S Cowley St Suite 6 Spokane WA 99202-1263 Ph: (509) 220-3048 |
| NPI Number | 1871558403 |
|---|---|
| Provider Enumeration Date | 04/18/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871558403 | NPI | - | NPPES |
| 7127715 | Medicaid | WA | |
| 300815300815 | Other | WA | PREMERA BLUE CROSS PROV # |
| P00260800 | Other | WA | PALMETTO GBA-RAILROAD MED |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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