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5952 Blackstone Way #100 Nine Mile Falls WA 99026 | |
(509) 464-0002 | |
(509) 464-2378 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 5952 Blackstone Way #100, Nine Mile Falls, Washington |
Authorized Official Name and Position | Donna Poe (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 5099356001 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 808 Chewelah WA 99109-0808 Ph: (509) 935-6001 | 5952 Blackstone Way #100 Nine Mile Falls WA 99026 Ph: (509) 464-0002 |
NPI Number | 1235455932 |
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Provider Enumeration Date | 04/20/2010 |
Last Update Date | 07/18/2023 |
Identifier | Type | State | Issuer |
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1235455932 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |