MEDICARE: CLALLAM COUNTY JAIL MEDICAL

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1518119403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLALLAM COUNTY JAIL MEDICAL

Provider Business Mailing Address
First Line	:	223 E 4TH ST
Second Line	:	SUITE 12
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3000
Country	:	US
Telephone Number	:	360-417-2592
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 E 4TH ST
Second Line	:	SUITE 12
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3000
Country	:	US
Telephone Number	:	360-417-2592
Fax Number	:

Authorized Official
Title or Position	:	FISCAL SPECIALIST
Name	:	KAREN E PETERSON
Credential	:
Telephone Number	:	360-417-2592

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	10/22/2008

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Directions to “CLALLAM COUNTY JAIL MEDICAL ” Practice Location

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