| NPI | 1083187124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEL EMERY CFO 360-475-6710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2019-04-30 |