Full Name | |
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Speciality | Clinic/Center |
Location | 6 13th Ave E, Polson, Montana |
Authorized Official Name and Position | Donald Wayne Anderson (ASST SEC FOR ENROLLMENT/DIR REIMB S) |
Authorized Official Contact | 4255255392 |
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 262 Liberty Lake WA 99019-0262 Ph: () - | 6 13th Ave E Polson MT 59860-5315 Ph: (406) 883-5680 |
NPI Number | 1609104165 |
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Provider Enumeration Date | 11/20/2009 |
Last Update Date | 10/29/2021 |
Medicare PECOS PAC ID | 0446230247 |
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Medicare Enrollment ID | O20100219000280 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609104165 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Wholeness In Health House-call Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 37926 Mt Highway 35, Polson, MT 59860 Phone: 406-261-5019 Fax: 406-883-6465 | |