Full Name | |
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Speciality | Clinic/Center |
Location | 1810 Hwy 508, Onalaska, Washington |
Authorized Official Name and Position | Steven Clark (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 3603309595 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
2690 Ne Kresky Ave Chehalis WA 98532-2412 Ph: (360) 330-9595 | 1810 Hwy 508 Onalaska WA 98570 Ph: (360) 978-6600 |
NPI Number | 1659631141 |
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Provider Enumeration Date | 05/18/2012 |
Last Update Date | 03/31/2016 |
Medicare PECOS PAC ID | 6002803749 |
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Medicare Enrollment ID | O20120622000546 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659631141 | NPI | - | NPPES |
G8801670 | Other | WA | MEDICARE GROUP |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |