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273 Sussex Ave E Tenino WA 98589-9359 | |
(360) 264-5665 | |
(360) 264-5666 |
Full Name | |
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Speciality | Family Medicine - Adolescent Medicine |
Location | 273 Sussex Ave E, Tenino, Washington |
Authorized Official Name and Position | Leyton Endicott Jump (SOLE MEMBER) |
Authorized Official Contact | 3602645665 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 4020 Tenino WA 98589-4020 Ph: (360) 264-5665 | 273 Sussex Ave E Tenino WA 98589-9359 Ph: (360) 264-5665 |
NPI Number | 1487056511 |
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Provider Enumeration Date | 09/19/2014 |
Last Update Date | 09/19/2014 |
Identifier | Type | State | Issuer |
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1487056511 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207QA0000X | Family Medicine - Adolescent Medicine | MD00022762 (Washington) | Primary |