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481 West E. St. Forks WA 98331-1918 | |
(360) 374-6642 | |
(360) 374-5335 |
Full Name | |
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Speciality | Family Medicine |
Location | 481 West E. St., Forks, Washington |
Authorized Official Name and Position | Richard Lee Dickson (PHYSICIAN/OWNER) |
Authorized Official Contact | 3603746642 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1918 Forks WA 98331-1918 Ph: (360) 374-6642 | 481 West E. St. Forks WA 98331-1918 Ph: (360) 374-6642 |
NPI Number | 1124210224 |
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Provider Enumeration Date | 08/13/2007 |
Last Update Date | 09/10/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124210224 | NPI | - | NPPES |
59570 | Other | WA | DEPT OF L & I |
7075542 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 600372068 (Washington) | Primary |
Chinook Pharmacy Clinical Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11 S Forks Ave Ste A, Forks, WA 98331 Phone: 360-374-2294 Fax: 360-374-5057 | |