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1501 Bay Ave Suite 201 Ocean Park WA 98640-4203 | |
(360) 642-3747 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1501 Bay Ave, Ocean Park, Washington |
Authorized Official Name and Position | Larry Cohen (CEO) |
Authorized Official Contact | 3606423181 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box N Ilwaco WA 98624-0319 Ph: () - | 1501 Bay Ave Suite 201 Ocean Park WA 98640-4203 Ph: (360) 642-3747 |
NPI Number | 1417482191 |
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Provider Enumeration Date | 05/01/2017 |
Last Update Date | 03/12/2019 |
Medicare PECOS PAC ID | 7214822105 |
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Medicare Enrollment ID | O20171115003436 |
Identifier | Type | State | Issuer |
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1417482191 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | HAC.FS00000079 (Washington) | Primary |