NPIMap

Organization Active NPI

Lake Chelan Clinic, P.C.

  • Rural Health Clinic/Center
  • Chelan, WA
National Provider Identifier
1073572855
Registry record updated Oct 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
503851 Issued in WA
Legal business name
LAKE CHELAN CLINIC, P.C.
Practice address
219 E Johnson Ave
Chelan, WA 98816-9160
Phone
(509) 682-2511
Fax
(509) 682-2515
NPI assigned
Mar 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2010

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

Authorized official

Name
Barbara Berg
Title
Administrator
Phone
(509) 682-2511

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 503851 WA Primary

Addresses

Primary practice location

219 E Johnson Ave
Chelan, WA 98816-9160

Mailing address

PO Box 368
Chelan, WA 98816-0368
Phone (509) 682-2511

Other identifiers 1

IdentifierTypeStateIssuer
7115603MedicaidWA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287532800000",
    "number": "1073572855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "CHELAN",
            "state": "WA",
            "postal_code": "988160368",
            "telephone_number": "509-682-2511",
            "fax_number": "509-682-2515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 E JOHNSON AVE",
            "city": "CHELAN",
            "state": "WA",
            "postal_code": "988169160",
            "telephone_number": "509-682-2511",
            "fax_number": "509-682-2515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CHELAN CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2010-10-20",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "509-682-2511"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "503851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7115603",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chelan, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; 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.