| Providence Medical Group Southeast Washington Rural Health Clinic | |
|
380 Chase Avenue Pmg Se Wa Rural Health Clinic Walla Walla WA 99362-2924 | |
| (509) 526-3333 | |
| (509) 526-8402 |
| Full Name | Providence Medical Group Southeast Washington Rural Health Clinic |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 380 Chase Avenue, Walla Walla, Washington |
| Authorized Official Name and Position | Michael Parenteau (CHIEF FINANCIAL OFFICIER) |
| Authorized Official Contact | 5095225890 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Southeast Washington Rural Health Clinic Po Box 34439 Mailing/credentialing Seattle WA 98124-1439 Ph: (509) 529-8905 | Providence Medical Group Southeast Washington Rural Health Clinic 380 Chase Avenue Pmg Se Wa Rural Health Clinic Walla Walla WA 99362-2924 Ph: (509) 526-3333 |
| NPI Number | 1891046926 |
|---|---|
| Provider Enumeration Date | 09/28/2012 |
| Last Update Date | 09/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891046926 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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