Healthcare Provider Details

I. General information

NPI: 1700815966
Provider Name (Legal Business Name): YAKIMA PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S 2ND ST SUITE B
SELAH WA
98942-1308
US

IV. Provider business mailing address

118 S 2ND ST SUITE B
SELAH WA
98942-1308
US

V. Phone/Fax

Practice location:
  • Phone: 509-698-3571
  • Fax: 509-698-3572
Mailing address:
  • Phone: 509-698-3571
  • Fax: 509-698-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH EELLS
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 509-966-5542