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NPI Code Detail

MEDICARE: CASCADE FAMILY MEDICAL CLINIC INC PS

MEDICARE: CASCADE FAMILY MEDICAL CLINIC INC PS
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
1207Q00000XFamily Medicine Physician600344469WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20031980OTHERWAL & I

General Provider Information

NPI Number : 1376536136
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASCADE FAMILY MEDICAL CLINIC INC PS
Provider Business Mailing Address
First Line : 1740 COOKS HILL RD
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-9071
Country : US
Telephone Number : 360-736-7623
Fax Number : 360-736-4074
Provider Business Practice Location Address
First Line : 1740 COOKS HILL RD
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-9071
Country : US
Telephone Number : 360-736-7623
Fax Number : 360-736-4074
Authorized Official
Title or Position : PRESIDENT
Name : CHRISTOPHER L YARTER
Credential : MD
Telephone Number : 360-736-7623
Provider Enumeration Date : 08/26/2005
Last Update Date : 09/20/2016

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Directions to “CASCADE FAMILY MEDICAL CLINIC INC PS ” Practice Location

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