| |
915 Vintage Valley Pkwy Ste 200 Zillah WA 98953-9800 | |
(509) 829-5151 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 915 Vintage Valley Pkwy Ste 200, Zillah, Washington |
Authorized Official Name and Position | Mathew Mathiesen (CFO) |
Authorized Official Contact | 5098371379 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 719 Sunnyside WA 98944-0719 Ph: (509) 837-1617 | 915 Vintage Valley Pkwy Ste 200 Zillah WA 98953-9800 Ph: (509) 829-5151 |
NPI Number | 1659809457 |
---|---|
Provider Enumeration Date | 05/24/2017 |
Last Update Date | 10/09/2024 |
Medicare PECOS PAC ID | 4082980065 |
---|---|
Medicare Enrollment ID | O20190109002710 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659809457 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 600581630 (Washington) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |