Full Name | |
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Speciality | Family Medicine |
Location | 510 E. Amende, Odessa, Washington |
Authorized Official Name and Position | John Serle (CEO) |
Authorized Official Contact | 5099822611 |
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 190 Odessa WA 99159 Ph: (509) 982-2611 | 510 E. Amende Odessa WA 99159 Ph: (509) 982-2611 |
NPI Number | 1740317544 |
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Provider Enumeration Date | 02/27/2007 |
Last Update Date | 04/20/2021 |
Medicare PECOS PAC ID | 1052209152 |
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Medicare Enrollment ID | O20040309001439 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740317544 | NPI | - | NPPES |
7013337 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | A.b. Harris |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1194746826 PECOS PAC ID: 5092723577 Enrollment ID: I20060324000130 |
Provider Name | Elizabeth M Stuhlmiller |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1477816502 PECOS PAC ID: 6305162009 Enrollment ID: I20150223001484 |