Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1720 2nd St, Cheney, Washington |
Authorized Official Name and Position | Aaron Wilson (CEO) |
Authorized Official Contact | 5094448888 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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611 N Iron Bridge Way Spokane WA 99202-4932 Ph: (509) 444-8888 | 1720 2nd St Cheney WA 99004-1910 Ph: (509) 444-8200 |
NPI Number | 1013387836 |
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Provider Enumeration Date | 10/06/2015 |
Last Update Date | 10/18/2021 |
Medicare PECOS PAC ID | 9638063217 |
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Medicare Enrollment ID | O20160114002916 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013387836 | NPI | - | NPPES |
94-1008 | Other | WA | MEDICARE PART A |
GAB11720 | Other | WA | MEDICARE PART B |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |