| |
1190 Riddle Street Darrington WA 98241 | |
(360) 436-1055 | |
(360) 436-0146 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1190 Riddle Street, Darrington, Washington |
Authorized Official Name and Position | Paul Ishizuka (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 3608145838 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1400 E. Kincaid Street Attn: Credentialing Mount Vernon WA 98274-4127 Ph: (360) 814-6724 | 1190 Riddle Street Darrington WA 98241 Ph: (360) 436-1055 |
NPI Number | 1013064575 |
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Provider Enumeration Date | 01/05/2007 |
Last Update Date | 09/24/2021 |
Medicare PECOS PAC ID | 6800793522 |
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Medicare Enrollment ID | O20160603001680 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013064575 | NPI | - | NPPES |
2058875 | Medicaid | WA | |
354488 | Other | WA | LABOR & INDUSTRIES |