| Yakima Medical Clinic Inc Pc | |
|
310 Holton Ave Yakima WA 98902 | |
| (509) 452-2508 | |
| (509) 452-7316 |
| Full Name | Yakima Medical Clinic Inc Pc |
|---|---|
| Speciality | Preferred Provider Organization |
| Location | 310 Holton Ave, Yakima, Washington |
| Authorized Official Name and Position | T Kent Vye (PRESIDENT) |
| Authorized Official Contact | 5094522508 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Yakima Medical Clinic Inc Pc 310 Holton Ave Yakima WA 98902 Ph: (509) 452-2508 | Yakima Medical Clinic Inc Pc 310 Holton Ave Yakima WA 98902 Ph: (509) 452-2508 |
| NPI Number | 1316079585 |
|---|---|
| Provider Enumeration Date | 03/12/2007 |
| Last Update Date | 10/15/2008 |
| Medicare PECOS PAC ID | 8224920996 |
|---|---|
| Medicare Enrollment ID | O20040326001178 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316079585 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0P00001175 (Washington) | Secondary |
| 305R00000X | Preferred Provider Organization | 0P00001175 (Washington) | Primary |
| Provider Name | Theodore Kent Vye |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609894278 PECOS PAC ID: 6305733841 Enrollment ID: I20100924000129 |
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