| Providence St Peter Internal Medi | |
|
8645 Martin Way E Bldg 2 Lacey WA 98516-5800 | |
| (360) 923-4600 | |
| (360) 923-4663 |
| Full Name | Providence St Peter Internal Medi |
|---|---|
| Speciality | Internal Medicine |
| Location | 8645 Martin Way E, Lacey, Washington |
| Authorized Official Name and Position | Nicole Quinn (PAYOR CREDENTIALING MANAGER) |
| Authorized Official Contact | 4255256715 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence St Peter Internal Medi Po Box 34439 Seattle WA 98124-1439 Ph: (425) 525-6778 | Providence St Peter Internal Medi 8645 Martin Way E Bldg 2 Lacey WA 98516-5800 Ph: (360) 923-4600 |
| NPI Number | 1194930313 |
|---|---|
| Provider Enumeration Date | 05/11/2007 |
| Last Update Date | 12/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194930313 | NPI | - | NPPES |
| 600 672 503 | Other | WA | TAX REGSTRATION NUMBER |
| 8943381 | Other | WA | L&I CRIME VICTIMS |
| 342 006 812 | Other | WA | UNIFIED BUSINESS ID # |
| 215633 | Other | WA | L&I |
| 7129661 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Washington) | Primary |
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (Washington) | Secondary |
Hawks Prairie Massage Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8830 Tallon Ln Ne, F, Lacey, WA 98516 Phone: 360-819-2877 | |
Saint Martin's University Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5000 Abbey Way Se, Lacey, WA 98503 Phone: 972-367-4845 | |
Providence St Peter Internal Medi Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1450 Northwest Lane Se, Lacey, WA 98503 Phone: 360-491-4460 Fax: 360-491-3090 | |
Providence Health & Services Washington Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 420 Golf Club Rd Se, Suite 203, Lacey, WA 98503 Phone: 360-493-7469 Fax: 360-459-2023 | |
Sweet Medical Group, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4524 Intelco Loop Se, Lacey, WA 98503 Phone: 360-491-9890 Fax: 360-667-5135 | |
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