Organization
MOBILE MEDICAL CLINIC CHESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAWNY B MILES (VICE PRESIDENT/ADMIN DIRECTOR)
(509) 220-3048
Entity
Organization
Contact information
Practice address
922 S COWLEY ST, SUITE 6, SPOKANE, WA 99202-1263
(509) 220-3048
(509) 279-0286
Mailing address
922 S COWLEY ST, SUITE 6, SPOKANE, WA 99202-1263
(509) 220-3048
(509) 279-0286
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300815300815
PREMERA BLUE CROSS PROV #
WA
05
—
7127715
—
WA
01
—
P00260800
PALMETTO GBA-RAILROAD MED
WA
Enumeration date
04/18/2006
Last updated
08/22/2020
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