MARYS CORNER MEDICAL CLINIC INC. PS NPI 1104016138

NPI Information

  • NPI: 1104016138
  • Provider Name: MARYS CORNER MEDICAL CLINIC INC. PS
  • Classification: Clinic/Center - 261QR1300X
  • Specialization: Rural Health
  • Entity Type: Organization
  • CLIA Number: 50D1013243
  • Address: 4254 JACKSON HIGHWAY
    CHEHALIS, WA
    ZIP 98532
  • Phone: (360) 262-3966

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NPI Details

MARYS CORNER MEDICAL CLINIC INC. PS is a rural health clinic center in Chehalis, WA. MARYS CORNER MEDICAL CLINIC INC. PS NPI is 1104016138. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4254 JACKSON HIGHWAY
CHEHALIS, WA
ZIP 98532
Phone: (360) 262-3966
Fax: (360) 262-3967

The provider's authorized official is Kimberly H Inglis .
The authorized official title is Office Manager and has the following contact phone number (360) 262-3966.

The CLIA number assigned to this NPI record is 50D1013243 - rural health clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/26/2007 and was last updated on 4/26/2012.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineMD00039760WASHINGTONNo
2363AM0700XPhysician AssistantMedicalPA10004588WASHINGTONNo
3261QR1300XClinic/CenterRural HealthWASHINGTONYes

Other Identifiers

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

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17132244MEDICAIDWASHINGTON
27132764MEDICAIDWASHINGTON
3503898MEDICARE OSCAR/CERTIFICATIONWASHINGTON
4G8875791MEDICARE PINWASHINGTON
5GAB37576MEDICARE PINWASHINGTON
61117829MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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