Organization
FAMILY HEALTH CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESUS HERNANDEZ (CEO)
(509) 422-7601
Entity
Organization
Contact information
Practice address
1400 TACOMA AVENUE, BRIDGEPORT, WA 98813
(509) 422-5700
(509) 422-7680
Mailing address
PO BOX 1340, OKANOGAN, WA 98840-1340
(509) 422-7674
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7060643
—
WA
Enumeration date
11/09/2022
Last updated
11/09/2022
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