| Providence St Peter Internal Medi | |
|
1450 Northwest Lane Se Lacey WA 98503-6908 | |
| (360) 491-4460 | |
| (360) 491-3090 |
| Full Name | Providence St Peter Internal Medi |
|---|---|
| Speciality | Family Medicine - Geriatric Medicine |
| Location | 1450 Northwest Lane Se, Lacey, Washington |
| Authorized Official Name and Position | Nicole Quinn (PAYOR CREDENTIALING MANAGER) |
| Authorized Official Contact | 4255256715 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence St Peter Internal Medi Po Box 34439 Seattle WA 98124-1439 Ph: (425) 525-6778 | Providence St Peter Internal Medi 1450 Northwest Lane Se Lacey WA 98503-6908 Ph: (360) 491-4460 |
| NPI Number | 1033309604 |
|---|---|
| Provider Enumeration Date | 07/30/2007 |
| Last Update Date | 12/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033309604 | NPI | - | NPPES |
| 8944993 | Other | WA | L&I CRIME VICTIMS |
| 342006812 | Other | WA | MASTER LICENSE WASHINGTON |
| 7138694 | Medicaid | WA | |
| 223577 | Other | WA | L&I |
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