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General NPI Number Information
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NPI Number | 1871558403
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL CLINIC CHESS INC
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 922 S COWLEY ST SUITE 6
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City | SPOKANE
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State | WA
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Zip | 99202-1263
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Country | US
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Telephone | 509-220-3048
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Fax | 509-279-0286
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Provider Business Mailing Address
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Address Line | 922 S COWLEY ST SUITE 6
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City | SPOKANE
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State | WA
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Zip | 99202-1263
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Country | US
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Telephone | 509-220-3048
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Fax | 509-279-0286
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Authorized Official
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Title or Position | VICE PRESIDENT/ADMIN DIRECTOR
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Name | MRS. TAWNY B MILES
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Credential |
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Telephone | 509-220-3048
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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 |
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License Number State |
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