Organization
PRIVIA MEDICAL GROUP WASHINGTON, PLLC
Active
Other names
Walla Walla Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN J MICHELSON (CEO)
(509) 525-3720
Entity
Organization
Contact information
Practice address
55 W TIETAN ST, WALLA WALLA, WA 99362-4445
(509) 525-3720
(509) 522-1292
Mailing address
55 W TIETAN ST, WALLA WALLA, WA 99362-4445
(509) 525-3720
(509) 522-1292
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
FX00058422
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7086820
—
WA
Enumeration date
05/30/2007
Last updated
10/06/2023
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