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714 W Pine St Newport WA 99156-9046 | |
(509) 447-2441 | |
(509) 447-0456 |
Full Name | |
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Speciality | Clinic/center |
Location | 714 W Pine St, Newport, Washington |
Authorized Official Name and Position | Tom Wilbur (CEO) |
Authorized Official Contact | 5094472441 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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714 W Pine St Newport WA 99156-9046 Ph: (509) 447-2441 | 714 W Pine St Newport WA 99156-9046 Ph: (509) 447-2441 |
NPI Number | 1720294002 |
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Provider Enumeration Date | 05/15/2007 |
Last Update Date | 11/06/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720294002 | NPI | - | NPPES |
7098395 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261Q00000X | Clinic/center | 264000780 (Washington) | Primary |