| Southwest Portland Medical Clinic Inc | |
|
3716 Pacific Ave Ste D Tacoma WA 98418-7836 | |
| (253) 474-7719 | |
| Not Available |
| Full Name | Southwest Portland Medical Clinic Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3716 Pacific Ave Ste D, Tacoma, Washington |
| Authorized Official Name and Position | Felino Bautista De Leon (PRESIDENT) |
| Authorized Official Contact | 4253069447 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Portland Medical Clinic Inc 6097 156th Pl Se Bellevue WA 98006-5307 Ph: (425) 785-6164 | Southwest Portland Medical Clinic Inc 3716 Pacific Ave Ste D Tacoma WA 98418-7836 Ph: (253) 474-7719 |
| NPI Number | 1245566843 |
|---|---|
| Provider Enumeration Date | 11/02/2009 |
| Last Update Date | 11/02/2009 |
| Medicare PECOS PAC ID | 1951568492 |
|---|---|
| Medicare Enrollment ID | O20120210000339 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245566843 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 00022250 (Washington) | Primary |
| Provider Name | Felino Bautista Deleon |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1255433132 PECOS PAC ID: 9335306133 Enrollment ID: I20120207000235 |
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