Healthcare Provider Details

I. General information

NPI: 1962664003
Provider Name (Legal Business Name): L. G. STECK MEMORIAL CLINIC, P. S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 COOKS HILL RD
CENTRALIA WA
98531-9071
US

IV. Provider business mailing address

PO BOX 1267
CHEHALIS WA
98532-0260
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-1965
  • Fax: 360-736-2539
Mailing address:
  • Phone: 360-736-1965
  • Fax: 360-736-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HARLEY DANIEL MILLER
Title or Position: SECERATARY
Credential: MD
Phone: 360-748-0211