| Ppm Washington Llc | |
|
1370 Bridge St Clarkston WA 99403-2332 | |
| (208) 401-1400 | |
| Not Available |
| Full Name | Ppm Washington Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1370 Bridge St, Clarkston, Washington |
| Authorized Official Name and Position | Lee Johnson (TREASURER) |
| Authorized Official Contact | 2084011369 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ppm Washington Llc 1675 E Riverside Dr Ste 200 Eagle ID 83616-7473 Ph: (208) 401-1400 | Ppm Washington Llc 1370 Bridge St Clarkston WA 99403-2332 Ph: (208) 401-1400 |
| NPI Number | 1568119204 |
|---|---|
| Provider Enumeration Date | 03/02/2022 |
| Last Update Date | 03/02/2022 |
| Medicare PECOS PAC ID | 0941697569 |
|---|---|
| Medicare Enrollment ID | O20220429001538 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568119204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Nicole M Loosbrock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508206483 PECOS PAC ID: 8022337542 Enrollment ID: I20150820009719 |
| Provider Name | Kimberly B Jabbes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700409018 PECOS PAC ID: 3971997495 Enrollment ID: I20220228001069 |
| Provider Name | Brandon Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932561115 PECOS PAC ID: 0446683338 Enrollment ID: I20230424001701 |
| Provider Name | Lisa Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912419243 PECOS PAC ID: 3870853724 Enrollment ID: I20230619001482 |
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