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Organization
MARYS CORNER MEDICAL CLINIC INC PS
Active
Organization
MARYS CORNER MEDICAL CLINIC INC PS
Active
Other names
Marys Corner Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KIMBERLY HOPE INGLIS (OFFICE MANAGER)
(360) 262-3966
Entity
Organization
Contact information
Practice address
4254 JACKSON HWY, CHEHALIS, WA 98532
(360) 262-3966
(360) 262-3967
Mailing address
4254 JACKSON HWY., CHEHALIS, WA 98532
(360) 262-3966
(360) 262-3967
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD00039760
WA
207Q00000X
Family Medicine Physician
Primary
OP00000823
WA
261QR1300X
Rural Health Clinic/Center
AP30005675
WA
261QR1300X
Rural Health Clinic/Center
MD00039760
WA
261QR1300X
Rural Health Clinic/Center
OP00000823
WA
261QR1300X
Rural Health Clinic/Center
PA0004588
WA
363AM0700X
Medical Physician Assistant
PA10004588
WA
363LF0000X
Family Nurse Practitioner
AP30005675
WA
Other
Enumeration date
09/09/2008
Last updated
04/30/2012
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