Organization Name: | LAKE CHELAN CLINIC, P.C. |
NPI Number: | 1073572855 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BARBARA BERG (ADMINISTRATOR) |
Mailing Address: | 219 E Johnson Ave Chelan |
State: | WA US |
Postal Code: | 988169160 |
Phone Number: | 5096822511 |
Fax Number: | 5096822515 |
NPI Enumeration Date: | 03/21/2006 |
NPI Last Update Date: | 10/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | 503851 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |