Organization
SAN JUAN HEALTHCARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BURK GOSSOM MD (OWNER)
(360) 378-1338
Entity
Organization
Contact information
Practice address
689 AIRPORT CENTER DR SUITE B, FRIDAY HARBOR, WA 98250
(360) 378-1338
(360) 378-8130
Mailing address
PO BOX 1550, FRIDAY HARBOR, WA 98250-1550
(360) 378-1338
(360) 378-1830
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0152516
LABOR AND INDUSTRIES
WA
01
—
361929500
PARKS NATL L&I
WA
01
—
50D0990556
CLIA
WA
01
—
602732862
UBI
WA
01
—
612622200
US NATL PARK SERVICE
WA
05
—
7135981
—
WA
05
—
7138829
—
WA
01
—
748121
GROUP HEALTH COOPERATIVE
WA
01
—
7990344
AETNA
WA
01
—
8937841
CRIME VICTIMS
WA
01
—
9451SA
REGENCE
WA
01
—
J5122
RAILROAD MEDICARE
WA
01
—
PENDING
MEDICARE
WA
01
—
POO425655DG2646
RAILROAD MEDICARE
WA
Enumeration date
07/17/2007
Last updated
03/04/2011
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