| Community Health Of Central Washington | |
|
915 Wisconsin Avenue Tieton WA 98947 | |
| (509) 673-0044 | |
| (509) 673-0054 |
| Full Name | Community Health Of Central Washington |
|---|---|
| Speciality | Clinic/Center |
| Location | 915 Wisconsin Avenue, Tieton, Washington |
| Authorized Official Name and Position | Angela Gonzalez (CEO) |
| Authorized Official Contact | 5094946700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Health Of Central Washington 501 S 5th Ave Yakima WA 98902-3550 Ph: (509) 494-6700 | Community Health Of Central Washington 915 Wisconsin Avenue Tieton WA 98947 Ph: (509) 673-0044 |
| NPI Number | 1700255874 |
|---|---|
| Provider Enumeration Date | 09/18/2015 |
| Last Update Date | 07/29/2020 |
| Medicare PECOS PAC ID | 4183536931 |
|---|---|
| Medicare Enrollment ID | O20151201002152 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700255874 | NPI | - | NPPES |
| 0031820 | Other | WA | LABOR AND INDUSTRIES |
| 901005 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |