# CEDAR CREST WHOLEHEALTHMEDICALCENTERPLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225363351
- **Authorized official:** KIM LEIANN TEITZEL (BILLING REPRESENTATIVE)
- **Authorized official phone:** (360) 785-0300

## Contact information

- **Practice address:** 100 CEDAR CREST DR, WINLOCK, WA 98596-9791
- **Practice address phone:** (360) 785-0300
- **Practice address fax:** (360) 785-3330
- **Mailing address:** 100 CEDAR CREST DR, WINLOCK, WA 98596-9791
- **Mailing address phone:** (360) 785-0300
- **Mailing address fax:** (360) 785-3330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0028509 | WA | Yes |

## Other

- **Enumeration date:** 10/07/2009
- **Last updated:** 10/07/2009