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294843 State Highway 101 Quilcene WA 98376 | |
(360) 765-3111 | |
(360) 765-3811 |
Full Name | |
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Speciality | Clinic/Center |
Location | 294843 State Highway 101, Quilcene, Washington |
Authorized Official Name and Position | Mike Glenn (CEO) |
Authorized Official Contact | 3603852200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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834 Sheridan St Port Townsend WA 98368-2443 Ph: (360) 385-2200 | 294843 State Highway 101 Quilcene WA 98376 Ph: (360) 765-3111 |
NPI Number | 1780897074 |
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Provider Enumeration Date | 05/07/2007 |
Last Update Date | 10/29/2020 |
Medicare PECOS PAC ID | 4789593708 |
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Medicare Enrollment ID | O20100927000358 |
Identifier | Type | State | Issuer |
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1780897074 | NPI | - | NPPES |
7056401 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Mark N Cherniack |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1982093472 PECOS PAC ID: 3072830991 Enrollment ID: I20150402000177 |