Marys Corner Medical Clinic Inc PS

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OP00000823 Issued in WA

Legal business name

MARYS CORNER MEDICAL CLINIC INC PS

Practice address

4254 Jackson Hwy
Chehalis, WA 98532

Phone

(360) 262-3966

Fax

(360) 262-3967

NPI assigned

Sep 9, 2008

Organization subpart

No

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

Authorized official

Name

Miss Kimberly Hope Inglis

Title

Office Manager

Phone

(360) 262-3966

Specialties & licenses 8

Addresses

Other identifiers 2

Other names 1

• Marys Corner Medical Clinic Former legal business name

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

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1194973628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4254 JACKSON HWY.",
            "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 HWY",
            "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": "2008-09-09",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "INGLIS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "HOPE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "360-262-3966",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00039760",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP00000823",
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "OP00000823",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "MD00039760",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "AP30005675",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "PA0004588",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004588",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP30005675",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7132244",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7132764",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marys Corner Medical Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kaylin Sheree Martin
• 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

• Family Medicine Physician in Chehalis, WA
• Providers in Chehalis, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; 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.