| |
14701 179th Ave Se Monroe WA 98272-1108 | |
(360) 794-7497 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 14701 179th Ave Se, Monroe, Washington |
Authorized Official Name and Position | Mark Judy (CEO) |
Authorized Official Contact | 3607941447 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
14701 179th Ave Se Monroe WA 98272-1108 Ph: (360) 794-7497 | 14701 179th Ave Se Monroe WA 98272-1108 Ph: (360) 794-7497 |
NPI Number | 1801960034 |
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Provider Enumeration Date | 11/20/2006 |
Last Update Date | 07/09/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801960034 | NPI | - | NPPES |
7034564 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 315001168 (Washington) | Primary |
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