| West Olympia Family Medicine Inc, Pc | |
|
402 Black Hills Ln Sw Ste B Olympia WA 98502-8146 | |
| (360) 754-4837 | |
| (360) 754-7304 |
| Full Name | West Olympia Family Medicine Inc, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 402 Black Hills Ln Sw Ste B, Olympia, Washington |
| Authorized Official Name and Position | Matthew T. Wellock (OWNER) |
| Authorized Official Contact | 3607544837 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Olympia Family Medicine Inc, Pc 1401 Marvin Rd Ne Ste 307 Pmb 266 Lacey WA 98516-5710 Ph: (360) 491-5055 | West Olympia Family Medicine Inc, Pc 402 Black Hills Ln Sw Ste B Olympia WA 98502-8146 Ph: (360) 754-4837 |
| NPI Number | 1225257363 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225257363 | NPI | - | NPPES |
| 1124098 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD00045733 (Washington) | Primary |
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