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General NPI Number Information
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NPI Number | 1477750651
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Entity Type | Organization
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Legal Business Name | COLVILLE HEALING ARTS CENTER PSC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 150 S ELM ST
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City | COLVILLE
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State | WA
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Zip | 99114-2834
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Country | US
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Telephone | 509-685-2300
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Fax | 509-685-0358
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Provider Business Mailing Address
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Address Line | 150 S ELM ST
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City | COLVILLE
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State | WA
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Zip | 99114-2834
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Country | US
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Telephone | 509-685-2300
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Fax | 509-685-0358
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Authorized Official
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Title or Position | OWNER
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Name | DR. LON MARSH HATFIELD
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Credential | M.D.
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Telephone | 509-685-2300
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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 | MD00014600
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License Number State | WA
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