Organization
CEDAR CREST WHOLEHEALTHMEDICALCENTERPLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LEIANN TEITZEL (BILLING REPRESENTATIVE)
(360) 785-0300
Entity
Organization
Contact information
Practice address
100 CEDAR CREST DR, WINLOCK, WA 98596-9791
(360) 785-0300
(360) 785-3330
Mailing address
100 CEDAR CREST DR, WINLOCK, WA 98596-9791
(360) 785-0300
(360) 785-3330
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0028509
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7117534
—
WA
Enumeration date
10/07/2009
Last updated
10/07/2009
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