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167 1st Avenue North Ilwaco WA 98624-0319 | |
(360) 642-6498 | |
(360) 642-0114 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 167 1st Avenue North, Ilwaco, Washington |
Authorized Official Name and Position | Joseph M Devin (CEO) |
Authorized Official Contact | 3606423181 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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167 1st Avenue North Ilwaco WA 98624-0000 Ph: (360) 642-6498 | 167 1st Avenue North Ilwaco WA 98624-0319 Ph: (360) 642-6498 |
NPI Number | 1871822676 |
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Provider Enumeration Date | 12/08/2009 |
Last Update Date | 07/14/2011 |
Identifier | Type | State | Issuer |
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1871822676 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |