| |
148 E Division Ave Morton WA 98356-9300 | |
(360) 496-5101 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 148 E Division Ave, Morton, Washington |
Authorized Official Name and Position | Steven Clark (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 3603309555 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
2690 Ne Kresky Ave Chehalis WA 98532-2412 Ph: (360) 330-9595 | 148 E Division Ave Morton WA 98356-9300 Ph: (360) 496-5101 |
NPI Number | 1700146206 |
---|---|
Provider Enumeration Date | 05/18/2012 |
Last Update Date | 11/20/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700146206 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |