Organization
PORT HADLOCK MEDICAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PEG CARLYLE CARLSON (OWNER)
(360) 379-6737
Entity
Organization
Contact information
Practice address
121 OAK BAY RD, PORT HADLOCK, WA 98339-8718
(360) 379-6737
(360) 379-6518
Mailing address
PO BOX 1208, PORT HADLOCK, WA 98339-1208
(360) 379-6737
(360) 379-6518
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9646688
—
WA
Enumeration date
10/25/2006
Last updated
12/11/2012
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