Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 101 1st Ave S, Ilwaco, Washington |
Authorized Official Name and Position | Larry Cohen (CEO) |
Authorized Official Contact | 3606426301 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box N Ilwaco WA 98624-0319 Ph: () - | 101 1st Ave S Ilwaco WA 98624-9100 Ph: (360) 642-2662 |
NPI Number | 1518334523 |
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Provider Enumeration Date | 08/25/2015 |
Last Update Date | 03/12/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518334523 | NPI | - | NPPES |