Walla Walla Clinic | |
55 W Tietan St Walla Walla WA 99362-4445 | |
(509) 525-3720 | |
(509) 522-1292 |
Full Name | Walla Walla Clinic |
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Speciality | Clinic/Center |
Location | 55 W Tietan St, Walla Walla, Washington |
Authorized Official Name and Position | Kevin J Michelson (CEO) |
Authorized Official Contact | 5095253720 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Walla Walla Clinic 55 W Tietan St Walla Walla WA 99362-4445 Ph: (509) 525-3720 | Walla Walla Clinic 55 W Tietan St Walla Walla WA 99362-4445 Ph: (509) 525-3720 |
NPI Number | 1346441979 |
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Provider Enumeration Date | 05/30/2007 |
Last Update Date | 10/06/2023 |
Medicare PECOS PAC ID | 2264320837 |
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Medicare Enrollment ID | O20110111000930 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346441979 | NPI | - | NPPES |
7086820 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | FX00058422 (Washington) | Primary |
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