| Quality Care Medical Clinic,llc | |
|
611 N 39th Ave Yakima WA 98902-6348 | |
| (509) 249-1288 | |
| (509) 249-6249 |
| Full Name | Quality Care Medical Clinic,llc |
|---|---|
| Speciality | Family Medicine |
| Location | 611 N 39th Ave, Yakima, Washington |
| Authorized Official Name and Position | Larry H Keller (MEMBER) |
| Authorized Official Contact | 5092491288 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Quality Care Medical Clinic,llc 611 N 39th Ave Yakima WA 98902-6348 Ph: (509) 249-1288 | Quality Care Medical Clinic,llc 611 N 39th Ave Yakima WA 98902-6348 Ph: (509) 249-1288 |
| NPI Number | 1285738799 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 04/13/2015 |
| Medicare PECOS PAC ID | 3274428008 |
|---|---|
| Medicare Enrollment ID | O20040219000438 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285738799 | NPI | - | NPPES |
| 7094048 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mark C Maiocco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891703997 PECOS PAC ID: 8921991449 Enrollment ID: I20040206000527 |
| Provider Name | Anatole Kim |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1477606549 PECOS PAC ID: 5799753331 Enrollment ID: I20040921000812 |
| Provider Name | Linda D Wrede Seaman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700895059 PECOS PAC ID: 9739149824 Enrollment ID: I20041013000668 |
| Provider Name | John W Lyzanchuk |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1730199860 PECOS PAC ID: 7315999893 Enrollment ID: I20050211000859 |
| Provider Name | Dianna M Kallis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679583702 PECOS PAC ID: 9537106448 Enrollment ID: I20050412001349 |
| Provider Name | Roy E Gondo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669476131 PECOS PAC ID: 5092746826 Enrollment ID: I20050822001098 |
| Provider Name | Bonnie L Kultgen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417967548 PECOS PAC ID: 9436176021 Enrollment ID: I20051102000442 |
| Provider Name | Tawnya E Tompkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487679122 PECOS PAC ID: 8527061290 Enrollment ID: I20060818000149 |
| Provider Name | Lisa Marie Benton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487933545 PECOS PAC ID: 5799956744 Enrollment ID: I20120810000487 |
| Provider Name | Jason William Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114571130 PECOS PAC ID: 8325379704 Enrollment ID: I20191016002112 |
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