Marys Corner Medical Clinic

LBN: Marys Corner Medical Clinic Inc Ps
Marys Corner Medical Clinic is an health care organization with primary practice located at 4254 Jackson Hwy , Chehalis WA 98532. The organization recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Ambulatory Health Care Facilities / Rural Health, Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Family. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty. Marys Corner Medical Clinic Inc Ps can be contacted via phone (360) 262-3966, or through Inglis, Kimberly Hope via phone (360) 262-3966.

Contact Information

Primary practice address
4254 Jackson Hwy Chehalis WA 98532
Phone: (360) 262-3966
Fax: (360) 262-3967
Website:
Map and Directions
Authorized official contact:
Name: Inglis, Kimberly Hope
Phone: (360) 262-3966

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD00039760 Washington
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X OP00000823 Washington
Ambulatory Health Care Facilities / Rural Health 261QR1300X OP00000823 Washington
Ambulatory Health Care Facilities / Rural Health 261QR1300X MD00039760 Washington
Ambulatory Health Care Facilities / Rural Health 261QR1300X AP30005675 Washington
Ambulatory Health Care Facilities / Rural Health 261QR1300X PA0004588 Washington
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA10004588 Washington
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP30005675 Washington

Profile Details

NPI number 1194973628
LBN Legal business name Marys Corner Medical Clinic Inc Ps
DBA Doing business as Marys Corner Medical Clinic
Authorized official Inglis, Kimberly Hope
Entity Organization
Organization subpart 1 No
Enumeration date Sep 9th, 2008
Last updated Apr 30th, 2012 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194973628 NPPES
Washington MEDICAID 7132244
Washington MEDICAID 7132764

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