| Black Hills Family Practice Clinic Ps | |
|
332 S Birch St Mccleary WA 98557-9522 | |
| (360) 495-3475 | |
| Not Available |
| Full Name | Black Hills Family Practice Clinic Ps |
|---|---|
| Speciality | Family Medicine |
| Location | 332 S Birch St, Mccleary, Washington |
| Authorized Official Name and Position | Edward R Macke (PRESIDENT) |
| Authorized Official Contact | 3604953475 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Hills Family Practice Clinic Ps Po Box 68 Mccleary WA 98557-0068 Ph: (360) 495-3475 | Black Hills Family Practice Clinic Ps 332 S Birch St Mccleary WA 98557-9522 Ph: (360) 495-3475 |
| NPI Number | 1467542399 |
|---|---|
| Provider Enumeration Date | 10/13/2006 |
| Last Update Date | 10/13/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467542399 | NPI | - | NPPES |
| 15628 | Other | SLI | |
| 008N | Other | BLUE CROSS | |
| 75243 | Other | UNIFORM | |
| 1009515 | Other | COMMUNITY H | |
| A002 | Other | TRICARE | |
| MA8267 | Other | REGENCE | |
| 95958 | Other | PACIFIC CARE | |
| QMXPR0055448 | Other | MOLINA | |
| 1252402 | Medicaid | WA | |
| 8009961 | Other | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Grays Harbor County Public Hospital District No. 1 Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 105 W Simpson Ave, Mccleary, WA 98557 Phone: 360-346-2222 |