Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 435 W Walnut St, Newport, Washington |
Authorized Official Name and Position | Donna Poe (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 5099356001 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 808 Chewelah WA 99109-0808 Ph: (509) 935-6001 | 435 W Walnut St Newport WA 99156 Ph: (509) 447-0888 |
NPI Number | 1407530157 |
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Provider Enumeration Date | 06/13/2023 |
Last Update Date | 07/18/2023 |
Medicare PECOS PAC ID | 1951202373 |
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Medicare Enrollment ID | O20240209003751 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407530157 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |