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NPI Code Detail

MEDICARE: WASHINGTON STATE DEPARTMENT OF CORRECTIONS-WASHINGTON STATE PENITENTIA

MEDICARE: WASHINGTON STATE DEPARTMENT OF CORRECTIONS-WASHINGTON STATE PENITENTIA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2400XPrison Health Clinic/Center

General Provider Information

NPI Number : 1164713558
Entity Type Code : Organization
Provider Name (Legal Business Name) : WASHINGTON STATE DEPARTMENT OF CORRECTIONS-WASHINGTON STATE PENITENTIA
Provider Business Mailing Address
First Line : PO BOX 41100, MAIL STOP 41100
Second Line :
City : OLYMPIA
State : WA
Zip : 98504-1100
Country : US
Telephone Number : 360-725-8213
Fax Number : 360-586-1320
Provider Business Practice Location Address
First Line : 1313 NORTH 13TH AVENUE
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-8817
Country : US
Telephone Number : 509-525-3610
Fax Number : 509-526-6406
Authorized Official
Title or Position : CHIEF MEDICAL OFFICER
Name : MARYANN CURL
Credential : M.D.
Telephone Number : 509-318-3498
Provider Enumeration Date : 04/20/2011
Last Update Date : 09/23/2024

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Directions to “WASHINGTON STATE DEPARTMENT OF CORRECTIONS-WASHINGTON STATE PENITENTIA ” Practice Location

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