Wilbur Clinic | |
214 Sw Main St Wilbur WA 99185 | |
(509) 647-5321 | |
(509) 647-2238 |
Full Name | Wilbur Clinic |
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Speciality | Clinic/Center |
Location | 214 Sw Main St, Wilbur, Washington |
Authorized Official Name and Position | Tyson E 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 |
---|---|
Wilbur Clinic 10 Nicholls St Davenport WA 99122-9729 Ph: (509) 725-7501 | Wilbur Clinic 214 Sw Main St Wilbur WA 99185 Ph: (509) 647-5321 |
NPI Number | 1972547610 |
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Provider Enumeration Date | 06/15/2006 |
Last Update Date | 07/18/2022 |
Medicare PECOS PAC ID | 3971591199 |
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Medicare Enrollment ID | O20081021000398 |
Identifier | Type | State | Issuer |
---|---|---|---|
1972547610 | NPI | - | NPPES |
CJ6525 | Other | WA | MEDICARE RAILROAD |
7101132 | Medicaid | WA | |
7117450 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | H-137 (Washington) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |