Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 481 West E St, Forks, Washington |
Authorized Official Name and Position | Richard L Dickson (OWNER PHYSICIAN) |
Authorized Official Contact | 3603746642 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1918 Forks WA 98331 Ph: (360) 374-6642 | 481 West E St Forks WA 98331 Ph: (360) 374-6642 |
NPI Number | 1720276207 |
---|---|
Provider Enumeration Date | 10/09/2007 |
Last Update Date | 02/13/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720276207 | NPI | - | NPPES |
7079999 | Medicaid | WA | |
59570 | Other | WA | DEPT OF L I |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (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 |