NPIMap

Organization Active NPI

David C Wynecoop Memorial Clinic DHHS IHS Wellpinit Service Unit

  • Clinic/Center
  • Wellpinit, WA
National Provider Identifier
1316034580
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
DAVID C WYNECOOP MEMORIAL CLINIC DHHS IHS WELLPINIT SERVICE UNIT
Practice address
6203 Agency Loop Rd
Wellpinit, WA 99040-0357
Phone
(509) 258-4517
Fax
(509) 258-7152
NPI assigned
Oct 6, 2006
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
Bill N Wiles
Title
Administrative Officer
Phone
(509) 258-4517

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

6203 Agency Loop Rd
Wellpinit, WA 99040-0357

Mailing address

6203 Agency Loop Road
PO Box 357
Wellpinit, WA 99040-0357
Phone (509) 258-4517

Other identifiers 3

IdentifierTypeStateIssuer
6021166MedicaidWA
4926309OtherWAPHARMACY NCPDP NUMBER
7100407MedicaidWA

Other names 1

  • WELLPINIT INDIAN HEALTH Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060308000863 TX Part B Supplier - Clinic/Group Practice 1850308313 Receives reassigned benefits from 8 practitioners
Practice locations: Wellpinit, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316034580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6203 AGENCY LOOP ROAD",
            "address_2": "PO BOX 357",
            "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 RD",
            "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 DHHS IHS WELLPINIT SERVICE UNIT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILES",
        "authorized_official_first_name": "BILL",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "509-258-4517"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6021166",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY NCPDP NUMBER",
            "identifier": "4926309",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100407",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WELLPINIT INDIAN HEALTH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.