| Snake River Adult Medicine Llc | |
|
1625 5th St Clarkston WA 99403-3001 | |
| (509) 295-8398 | |
| (509) 295-8416 |
| Full Name | Snake River Adult Medicine Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1625 5th St, Clarkston, Washington |
| Authorized Official Name and Position | Brian Francis Ciezki (OWNER/OPERATOR) |
| Authorized Official Contact | 5092958398 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Snake River Adult Medicine Llc 725 Diagonal St Clarkston WA 99403-2043 Ph: (509) 295-8398 | Snake River Adult Medicine Llc 1625 5th St Clarkston WA 99403-3001 Ph: (509) 295-8398 |
| NPI Number | 1548752918 |
|---|---|
| Provider Enumeration Date | 06/01/2018 |
| Last Update Date | 01/19/2022 |
| Medicare PECOS PAC ID | 4385992569 |
|---|---|
| Medicare Enrollment ID | O20180803001162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548752918 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 604282863 (Washington) | Primary |
| Provider Name | Brian Francis Ciezki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205221041 PECOS PAC ID: 5294056305 Enrollment ID: I20180202001614 |
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