| 11th Avenue Family Medicine Clinic | |
|
314 S 11th Ave Yakima WA 98902-3212 | |
| (509) 902-8585 | |
| (509) 902-2030 |
| Full Name | 11th Avenue Family Medicine Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 314 S 11th Ave, Yakima, Washington |
| Authorized Official Name and Position | Shannon Fernandez (VP OF BILLING) |
| Authorized Official Contact | 5088656175 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 11th Avenue Family Medicine Clinic Po Box 190 Toppenish WA 98948-0190 Ph: (509) 865-6175 | 11th Avenue Family Medicine Clinic 314 S 11th Ave Yakima WA 98902-3212 Ph: (509) 902-8585 |
| NPI Number | 1033677307 |
|---|---|
| Provider Enumeration Date | 03/06/2019 |
| Last Update Date | 11/01/2022 |
| Medicare PECOS PAC ID | 4385541986 |
|---|---|
| Medicare Enrollment ID | O20200929000541 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033677307 | NPI | - | NPPES |
| 600304660-001-0040 | Other | WA | STATE BUSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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