Shane R. Son, Md, Pllc | |
412 Black Hills Ln Sw Ste A Olympia WA 98502-8142 | |
(360) 528-2100 | |
(360) 528-2104 |
Full Name | Shane R. Son, Md, Pllc |
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Speciality | Clinic/Center |
Location | 412 Black Hills Ln Sw Ste A, Olympia, Washington |
Authorized Official Name and Position | Shane Rizarri Son (PHYSICIAN) |
Authorized Official Contact | 3605282100 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Shane R. Son, Md, Pllc Po Box 12389 Olympia WA 98508-2389 Ph: (360) 528-2100 | Shane R. Son, Md, Pllc 412 Black Hills Ln Sw Ste A Olympia WA 98502-8142 Ph: (360) 528-2100 |
NPI Number | 1518166040 |
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Provider Enumeration Date | 07/14/2007 |
Last Update Date | 05/10/2011 |
Medicare PECOS PAC ID | 7810098019 |
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Medicare Enrollment ID | O20070718000181 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518166040 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | MD00041776 (Washington) | Primary |
Provider Name | Shane R Son |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1225180698 PECOS PAC ID: 6305809856 Enrollment ID: I20041105000881 |
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