| Walla Walla Clinic, Inc. | |
|
10 Ne 5th Ave Milton Freewater OR 97862-1702 | |
| (541) 938-3314 | |
| (541) 938-4449 |
| Full Name | Walla Walla Clinic, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 10 Ne 5th Ave, Milton Freewater, Oregon |
| Authorized Official Name and Position | Kevin Michelson (CEO) |
| Authorized Official Contact | 5095253720 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Walla Walla Clinic, Inc. 55 W Tietan St Walla Walla WA 99362-4445 Ph: (509) 525-3720 | Walla Walla Clinic, Inc. 10 Ne 5th Ave Milton Freewater OR 97862-1702 Ph: (541) 938-3314 |
| NPI Number | 1063521862 |
|---|---|
| Provider Enumeration Date | 08/29/2006 |
| Last Update Date | 12/18/2017 |
| Medicare PECOS PAC ID | 2264320837 |
|---|---|
| Medicare Enrollment ID | O20040305000581 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063521862 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Scott T Fry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972577195 PECOS PAC ID: 2163491820 Enrollment ID: I20050701000609 |
| Provider Name | Sarah E Scarborough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649369505 PECOS PAC ID: 1153318514 Enrollment ID: I20061121000013 |
| Provider Name | Abby Bettilyon Sorensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902289838 PECOS PAC ID: 3678880846 Enrollment ID: I20190820002732 |