| Rejuventa Medical Corp. | |
|
1755 Kresky Ave. Centralia WA 98531 | |
| (360) 669-0098 | |
| (360) 669-0121 |
| Full Name | Rejuventa Medical Corp. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1755 Kresky Ave., Centralia, Washington |
| Authorized Official Name and Position | Guito C Wingfield (PRESIDENT) |
| Authorized Official Contact | 9174941002 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rejuventa Medical Corp. 1755 Kresky Ave. Box 16 Centralia WA 98531 Ph: (360) 669-0098 | Rejuventa Medical Corp. 1755 Kresky Ave. Centralia WA 98531 Ph: (360) 669-0098 |
| NPI Number | 1013550987 |
|---|---|
| Provider Enumeration Date | 10/23/2019 |
| Last Update Date | 10/17/2023 |
| Medicare PECOS PAC ID | 6305270844 |
|---|---|
| Medicare Enrollment ID | O20191216003122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013550987 | NPI | - | NPPES |
| MD00048810 | Other | WA | WASHINGTON STATE MEDICAL LICENSE |
| 1699792242 | Other | WA | NPI |
| 1013550987 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Wanda Jimenez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306867700 PECOS PAC ID: 2466419270 Enrollment ID: I20080930000259 |
| Provider Name | Guito Wingfield |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699792242 PECOS PAC ID: 5597720490 Enrollment ID: I20080930000350 |
Washington Park Medical Center, Inc Ps Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 208 Centralia College Blvd, Centralia, WA 98531 Phone: 360-736-0771 Fax: 360-736-4867 | |
Dr. Thomas Cooke Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1217 Mellen St, Centralia, WA 98531 Phone: 360-736-4021 Fax: 360-736-3541 | |
Lewis County Community Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 711 Harrison Ave, Centralia, WA 98531 Phone: 360-736-5405 Fax: 360-736-5620 | |
Pmg Sw Wa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1010 S Scheuber Rd, Centralia, WA 98531 Phone: 360-827-7966 | |
Cascade Family Medical Clinic Inc Ps Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1740 Cooks Hill Rd, Centralia, WA 98531 Phone: 360-736-7623 Fax: 360-736-4074 | |
Valley View Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 220 Washington Way, Centralia, WA 98531 Phone: 360-388-3259 Fax: 360-807-4933 |