Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 11245 Sr 525, Clinton, Washington |
Authorized Official Name and Position | Garth A Miller (COO) |
Authorized Official Contact | 3606787656 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 24789 Seattle WA 98124-0789 Ph: (360) 678-7656 | 11245 Sr 525 Clinton WA 98236 Ph: (360) 341-5252 |
NPI Number | 1154361590 |
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Provider Enumeration Date | 06/07/2006 |
Last Update Date | 07/20/2023 |
Medicare PECOS PAC ID | 1658280680 |
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Medicare Enrollment ID | O20030417000036 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154361590 | NPI | - | NPPES |
7105513 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 000092 (Washington) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |