| Mss Program Walla Walla | |
|
1120 W Rose St Walla Walla WA 99362-1662 | |
| (509) 525-6695 | |
| Not Available |
| Full Name | Mss Program Walla Walla |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1120 W Rose St, Walla Walla, Washington |
| Authorized Official Name and Position | Juan Carlos Olivares (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5098656175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mss Program Walla Walla 1120 W Rose St Walla Walla WA 99362-1662 Ph: (509) 525-6695 | Mss Program Walla Walla 1120 W Rose St Walla Walla WA 99362-1662 Ph: (509) 525-6695 |
| NPI Number | 1992834196 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992834196 | NPI | - | NPPES |
| 7401946 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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