NPIMap

Organization Active NPI

David C Wynecoop Memorial Clinic

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Wellpinit, WA
National Provider Identifier
1003963000
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
DAVID C WYNECOOP MEMORIAL CLINIC
Practice address
6203 Agency Loop Road
Wellpinit, WA 99040-0357
Phone
(509) 258-4517
Fax
(509) 258-7152
NPI assigned
Jan 4, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William N Wiles
Title
Administrative Officer
Phone
(509) 258-4517

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X Primary

Addresses

Primary practice location

6203 Agency Loop Road
Wellpinit, WA 99040-0357

Mailing address

6203 Agency Loop Road
Wellpinit, WA 99040-0357
Phone (509) 258-4517

Other identifiers 3

IdentifierTypeStateIssuer
4926309OtherWANCPDP NUMBER
PH00052198OtherWALICENSE
PH00044329OtherWALICENSE

National Provider Directory

National Provider Directory
Tax ID family
David C Wynecoop Memorial Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003963000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6203 AGENCY LOOP ROAD",
            "city": "WELLPINIT",
            "state": "WA",
            "postal_code": "990400357",
            "telephone_number": "509-258-4517",
            "fax_number": "509-258-7152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6203 AGENCY LOOP ROAD",
            "city": "WELLPINIT",
            "state": "WA",
            "postal_code": "990400357",
            "telephone_number": "509-258-4517",
            "fax_number": "509-258-7152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID C WYNECOOP MEMORIAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "509-258-4517"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "4926309",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PH00052198",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PH00044329",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellpinit, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.