Marys Corner Medical Clinic Inc. PS

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

MARYS CORNER MEDICAL CLINIC INC. PS

Practice address

4254 Jackson Highway
Chehalis, WA 98532

Phone

(360) 262-3966

Fax

(360) 262-3967

NPI assigned

Jul 26, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Kimberly H Inglis

Title

Office Manager

Phone

(360) 262-3966

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Rural health clinic certification: CCN 503898

Legal name

MARY'S CORNER MEDICAL CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 10, 2005

Last certification

Sep 29, 2022

Ownership / control type

1B

Facility address

4254 Jackson Highway
Chehalis, WA 98532

Practitioners 1

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

• Robert Dean McElhaney Jr., MD

  • Family Medicine Physician
  • Chehalis, WA
  • NPI 1730162124
  NPD (past)

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335398400000",
    "number": "1104016138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4254 JACKSON HIGHWAY",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "98532",
            "telephone_number": "360-262-3966",
            "fax_number": "360-262-3967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4254 JACKSON HIGHWAY",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "98532",
            "telephone_number": "360-262-3966",
            "fax_number": "360-262-3967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYS CORNER MEDICAL CLINIC INC. PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2012-04-26",
        "status": "A",
        "authorized_official_last_name": "INGLIS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "360-262-3966",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00039760",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004588",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7132764",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1117829",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7132244",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taeya Aileene Martin
• Carlos Alberto Martinez, B.A.
• Destin Rae Martini, SUDP
• Joanne Marty
• Marys Corner Medical Clinic Inc PS
• Massage by Cora Yoone PLLC
• Venus H Masters, LMHC
• Cindy Mathey
• Derrik Hunter Mattox-Hanson
• Elissa K Maynard, DDS

• Rural Health Clinic/Center in Chehalis, WA
• Providers in Chehalis, WA by specialty
• Rural Health Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.