MEDICARE: QUALICENTERS INLAND NORTHWEST, LLC

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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1215196787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALICENTERS INLAND NORTHWEST, LLC

Provider Business Mailing Address
First Line	:	5616 OCEAN BEACH HWY
Second Line	:	SUITE 260
City	:	LONGVIEW
State	:	WA
Zip	:	98632-6222
Country	:	US
Telephone Number	:	360-425-2460
Fax Number	:

Provider Business Practice Location Address
First Line	:	5616 OCEAN BEACH HWY
Second Line	:	SUITE 260
City	:	LONGVIEW
State	:	WA
Zip	:	98632-6222
Country	:	US
Telephone Number	:	360-425-2460
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	MARK FAWCETT
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	08/02/2012

Similar Medicare Providers

1548840036 — RENAL CARE GROUP NORTHWEST, INC.
Practice Location Address:

5618 OCEAN BEACH HWY
LONGVIEW, WA
98632-6222

Practice Phone: 360-562-4340
Practice Fax:

1033006150 — PAULO VIANNEY VILELA RODRIGUES PHD, MSN, RN, BS.
Practice Location Address:

1615 DELAWARE ST
LONGVIEW, WA
98632-2367

Practice Phone: 360-636-4865
Practice Fax:

1164379251 — DORA SPRAGUE CPC
Practice Location Address:

1340 12TH AVE
LONGVIEW, WA
98632-3820

Practice Phone: 360-200-5419
Practice Fax: 844-612-6673

1699623751 — JESSICA STOHR RDH
Practice Location Address:

1230 7TH AVE
LONGVIEW, WA
98632-3166

Practice Phone: 800-813-2000
Practice Fax:

1477222156 — MS. FAITH CLAIR TREVINO MSW, LICSWA
Practice Location Address:

1400 COMMERCE AVE
LONGVIEW, WA
98632-3756

Practice Phone: 360-998-3050
Practice Fax:

1225619778 — KILEY S RADICH MSW, LICSWA
Practice Location Address:

748 14TH AVE
LONGVIEW, WA
98632-2315

Practice Phone: 360-200-5419
Practice Fax: 360-200-6736

Directions to “QUALICENTERS INLAND NORTHWEST, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.