Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 600 E. Main Street, Elma, Washington |
Authorized Official Name and Position | Renee K Jensen (CEO) |
Authorized Official Contact | 3604953244 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
600 E. Main Street Elma WA 98541 Ph: () - | 600 E. Main Street Elma WA 98541 Ph: (360) 495-3244 |
NPI Number | 1942554183 |
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Provider Enumeration Date | 11/08/2012 |
Last Update Date | 11/04/2013 |
Medicare PECOS PAC ID | 9032017256 |
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Medicare Enrollment ID | O20130215000030 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942554183 | NPI | - | NPPES |
7103815 | Medicaid | WA | |
AB18052 | Other | WA | GROUP MEDICARE NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | HAC.FS.00000186 (Washington) | Secondary |
261QR1300X | Clinic/center - Rural Health | HAC.FS.00000186 (Washington) | Primary |
Pacific Medical Specialty Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1117 W Young St, Elma, WA 98541 Phone: 503-805-8865 | |
Olympic Valley Clinic, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 11 Schouweiler Rd, Elma, WA 98541 Phone: 360-482-5300 Fax: 360-482-5900 | |