DAVID C WYNECOOP MEMORIAL CLINIC NPI 1003963000

NPI Information

DAVID C WYNECOOP MEMORIAL CLINIC is an indian health service tribal urban indian health i t u pharmacy in Wellpinit, WA. The provider is an Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. DAVID C WYNECOOP MEMORIAL CLINIC NPI is 1003963000. The provider is registered as an organization entity type.

The provider's business location address is:

6203 AGENCY LOOP ROAD
WELLPINIT, WA
ZIP 99040-357
Phone: (509) 258-4517
Fax: (509) 258-7152

The provider's authorized official is William N Wiles .
The authorized official title is Administrative Officer and has the following contact phone number (509) 258-4517.

The CLIA number assigned to this NPI record is 50D0669238 - other - tribal with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/4/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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