Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1003 Koala Dr., Omak, Washington |
Authorized Official Name and Position | Jesus Hernandez (CEO) |
Authorized Official Contact | 5094225700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1340 Okanogan WA 98840-1340 Ph: (509) 422-5700 | 1003 Koala Dr. Omak WA 98841 Ph: (509) 422-5700 |
NPI Number | 1306005715 |
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Provider Enumeration Date | 06/02/2008 |
Last Update Date | 01/19/2021 |
Medicare PECOS PAC ID | 9739076217 |
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Medicare Enrollment ID | O20081211000834 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306005715 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 600625131 (Washington) | Primary |
Full Circle Health And Wellness Center Pllp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 208 S Main St, Omak, WA 98841 Phone: 509-560-3928 | |