| L. Keith Hanson Pllc | |
|
520 W. Indian Avenue Brewster WA 98812 | |
| (590) 689-2525 | |
| (509) 689-3247 |
| Full Name | L. Keith Hanson Pllc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 520 W. Indian Avenue, Brewster, Washington |
| Authorized Official Name and Position | Melodie White (ADMINISTRATOR) |
| Authorized Official Contact | 5096892525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| L. Keith Hanson Pllc Po Box 337 Brewster WA 98812-0337 Ph: (509) 689-2525 | L. Keith Hanson Pllc 520 W. Indian Avenue Brewster WA 98812 Ph: (590) 689-2525 |
| NPI Number | 1316138720 |
|---|---|
| Provider Enumeration Date | 08/09/2007 |
| Last Update Date | 01/11/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316138720 | NPI | - | NPPES |
| 7126980 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 503894 (Washington) | Primary |
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