| R & B Fleck Enterprises, Llc | |
|
1365 Beet Rd Walla Walla WA 99362-7180 | |
| (509) 520-1794 | |
| (509) 529-5860 |
| Full Name | R & B Fleck Enterprises, Llc |
|---|---|
| Speciality | General Practice |
| Location | 1365 Beet Rd, Walla Walla, Washington |
| Authorized Official Name and Position | Ronald Wayne Fleck (PRESIDENT) |
| Authorized Official Contact | 5095201794 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| R & B Fleck Enterprises, Llc 1365 Beet Rd Walla Walla WA 99362-7180 Ph: (509) 520-1794 | R & B Fleck Enterprises, Llc 1365 Beet Rd Walla Walla WA 99362-7180 Ph: (509) 520-1794 |
| NPI Number | 1225163926 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 02/26/2008 |
| Medicare PECOS PAC ID | 2466438171 |
|---|---|
| Medicare Enrollment ID | O20040624001325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225163926 | NPI | - | NPPES |
| 1328202 | Medicaid | WA | |
| G8803274 | Other | WA | MEDICARE ID GROUP NUMBER |
| 1578629226 | Other | WA | INDIVIDUAL NPI # |
| 7121478 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 252090019815 (Washington) | Primary |
| Provider Name | Ronald W Fleck |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1578629226 PECOS PAC ID: 9234115940 Enrollment ID: I20040720001083 |
| Provider Name | Douglas Edward Griffith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477195196 PECOS PAC ID: 1052746518 Enrollment ID: I20200110002415 |
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