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7803 Ne Fourth Plain Blvd Vancouver WA 98662-7294 | |
| (360) 768-9030 | |
| (360) 768-9031 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 7803 Ne Fourth Plain Blvd, Vancouver, Washington |
| Authorized Official Name and Position | Mary Bartolo (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Contact | 2067635277 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 34703 Seattle WA 98124-1703 Ph: () - | 7803 Ne Fourth Plain Blvd Vancouver WA 98662-7294 Ph: (360) 768-9030 |
| NPI Number | 1245876580 |
|---|---|
| Provider Enumeration Date | 11/21/2019 |
| Last Update Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245876580 | NPI | - | NPPES |
| 2150133 | Medicaid | WA |
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