| North Basin Medical Clinics--davenport Clinic | |
|
10 Nicholls St Davenport WA 99122-9729 | |
| (509) 725-7501 | |
| (509) 725-7504 |
| Full Name | North Basin Medical Clinics--davenport Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 10 Nicholls St, Davenport, Washington |
| Authorized Official Name and Position | Tyson Lacy (CEO) |
| Authorized Official Contact | 5097252979 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Basin Medical Clinics--davenport Clinic 10 Nicholls St Davenport WA 99122-9729 Ph: (509) 725-7501 | North Basin Medical Clinics--davenport Clinic 10 Nicholls St Davenport WA 99122-9729 Ph: (509) 725-7501 |
| NPI Number | 1558309518 |
|---|---|
| Provider Enumeration Date | 06/03/2006 |
| Last Update Date | 07/07/2022 |
| Medicare PECOS PAC ID | 3971591199 |
|---|---|
| Medicare Enrollment ID | O20080512000261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558309518 | NPI | - | NPPES |
| 7101132 | Medicaid | WA | |
| 7117450 | Medicaid | WA | |
| CJ6525 | Other | WA | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | H-137 (Washington) | Secondary |
| 208600000X | Surgery | H-137 (Washington) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
North Basin Medical Clinics Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10 Nicholls St, Davenport, WA 99122 Phone: 509-725-7501 Fax: 509-725-7504 | |
Lavender Luxe Massage Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 3rd St Ste 100, Davenport, WA 99122 Phone: 509-725-3333 Fax: 509-725-3334 |