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10 Ros Circle Republic WA 99166-9701 | |
| (509) 775-3153 | |
| (509) 775-8929 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 10 Ros Circle, Republic, Washington |
| Authorized Official Name and Position | Gary Robertson (CHIEF EXECUTIVE OFFI) |
| Authorized Official Contact | 5094453333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
36 Klondike Rd Republic WA 99166-9701 Ph: (509) 775-3153 | 10 Ros Circle Republic WA 99166-9701 Ph: (509) 775-3153 |
| NPI Number | 1184776916 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 03/24/2014 |
| Medicare PECOS PAC ID | 0446148761 |
|---|---|
| Medicare Enrollment ID | O20070920000639 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184776916 | NPI | - | NPPES |
| 7113970 | Medicaid | WA | |
| 7033210 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |