Organization
MARYS CORNER MEDICAL CLINIC INC. PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY H INGLIS (OFFICE MANAGER)
(360) 262-3966
Entity
Organization
Contact information
Practice address
4254 JACKSON HIGHWAY, CHEHALIS, WA 98532
(360) 262-3966
(360) 262-3967
Mailing address
4254 JACKSON HIGHWAY, CHEHALIS, WA 98532
(360) 262-3966
(360) 262-3967
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD00039760
WA
261QR1300X
Rural Health Clinic/Center
Primary
—
WA
363AM0700X
Medical Physician Assistant
PA10004588
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1117829
—
WA
05
—
7132244
—
WA
05
—
7132764
—
WA
Enumeration date
07/26/2007
Last updated
04/26/2012
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