| |
610 E Main Street Elma WA 98541-9551 | |
(360) 346-2222 | |
(360) 346-2163 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 610 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 St Elma WA 98541-9560 Ph: (360) 346-2222 | 610 E Main Street Elma WA 98541-9551 Ph: (360) 346-2222 |
NPI Number | 1811025216 |
---|---|
Provider Enumeration Date | 02/28/2007 |
Last Update Date | 01/18/2019 |
Medicare PECOS PAC ID | 9032017256 |
---|---|
Medicare Enrollment ID | O20101105000276 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811025216 | NPI | - | NPPES |
7103815 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | 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 |