Moses Lake Community Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Moses Lake, WA
NPI 1699862813 · NPPES record last updated Aug 1, 2014
Key facts
- NPI
- 1699862813
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 601352250 (WA)
- Legal business name
- MOSES LAKE COMMUNITY HEALTH CENTER
- Practice address
- 605 S Coolidge St
Moses Lake, WA 98837-1893 - Phone
- (509) 765-0674
- Fax
- (509) 765-6591
- NPI assigned
- Oct 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Sheila A Chilson
- Title
- Chief Executive Officer
- Phone
- (509) 765-0674
Other NPIs with the same Medicare PAC ID 2
Practitioners 179
-
Eric Aronsohn, PA-C
-
Michael T Bayona, M.D.
-
Cameron M. Beck, MD
-
Frank Weston Beck, PA-C
-
Logan Beebe, D.O.
-
James Buratto, M.D.
-
Sierra Butler, PA-C
-
Jennipher Colas, PA-C
-
Tammy Countryman, LICSW
-
Lori Ann Crane, ARNP
-
Irene Cruite, M.D.
-
Joshua David Garcia, M.D.
-
Eric William Graham, M.D.
-
Brett A Greenburg, PA-C
-
Matthew Hardy, M.S., D.O.
-
Leona M Hays, ARNP
-
Rebecca Helton, FNP-BC
-
Cole Q Hemmerling, M.D.
-
John Jamison, ARNP
-
Shawn R Jones, MD
-
Heather Christine Kappel, LMHCA
-
Chloe Noel Kesterson, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA
Federally qualified health center certification: CCN 501891
- Legal name
- MOSES LAKE COMMUNITY HEALTH CENTER
- Doing business as
- QUINCY COMMUNITY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 7, 2005
- Last certification
- Dec 7, 2005
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Incorporated
- Dec 3, 1991 in WA
- Enrollment address
- 605 S Coolidge St
Moses Lake, WA 98837-1893
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Amalia Campos |
Corporate Officer |
Dec 17, 2012 | |
| Amy Raymond |
Corporate Director |
Nov 24, 2010 | |
| Sharon Lange |
Corporate Director |
Nov 24, 2010 | |
| Sheila Chilson |
Corporate Officer |
Nov 24, 2010 | |
| Corporate Director |
Nov 24, 2010 | ||
| W-2 Managing Employee |
Feb 4, 2012 | 100% | |
| Sheryl Delgado |
Corporate Director |
Nov 24, 2010 | |
| Matthew Benson |
Corporate Officer |
Jun 1, 2011 | |
| Amanda Barta |
Corporate Officer |
Mar 1, 2014 | |
| Corporate Director |
Mar 1, 2014 | ||
| Carol Schimke |
Corporate Director |
Nov 24, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031121000667 | WA | Part B Supplier - Clinic/Group Practice | 1254235138 |
Receives reassigned benefits from 157 practitioners Practice locations: Moses Lake, WA; Quincy, WA |
| O20110126000043 | WA | Part a Provider - Federally Qualified Health Center (FQHC) | 1254235138 | Practice locations: Moses Lake, WA |
National Provider Directory
Locations
801 E Wheeler Rd
Moses Lake, WA 98837
Phone (509) 765-5606
605 S Coolidge St
#101
Moses Lake, WA 98837
Phone (509) 765-0674
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 601352250 | WA | Yes |
Addresses
Primary practice location
605 S Coolidge St
Moses Lake, WA 98837-1893
Mailing address
605 S Coolidge St
Moses Lake, WA 98837-1893
Phone (509) 765-0674
Other providers in Moses Lake, WA
- Moses Lake Community Health Center
- Moses Lake Community Health Center
- Moses Lake Community Health Center
- Moses Lake Community Health Center
- Moses Lake Community Health Center
- Moses Lake Community Health Center
- Moses Lake Community Health Center
- Moses Lake Family Dentistry
- Moses Lake Operations LLC
- Moses Lake Orthodontics LLC
All providers in Moses Lake, WA · Federally Qualified Health Center (FQHC) in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.