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General NPI Number Information
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NPI Number | 1225251390
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Entity Type | Organization
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Legal Business Name | CONVENIENT PHYSICIANS SERVICES PS
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 1052 DOUGLAS ST
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City | LONGVIEW
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State | WA
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Zip | 98632-2102
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Country | US
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Telephone | 360-425-5845
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Fax | 360-577-9066
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Provider Business Mailing Address
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Address Line | 1052 DOUGLAS ST
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City | LONGVIEW
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State | WA
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Zip | 98632-2102
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Country | US
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Telephone | 360-425-5845
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Fax | 360-577-9066
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BERT MICHAEL HALE
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Credential | MD
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Telephone | 360-425-5845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00016670
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License Number State | WA
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