Provider Demographics
NPI:1871558403
Name:MOBILE MEDICAL CLINIC CHESS INC
Entity type:Organization
Organization Name:MOBILE MEDICAL CLINIC CHESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/ADMIN DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAWNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-220-3048
Mailing Address - Street 1:922 S COWLEY ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1263
Mailing Address - Country:US
Mailing Address - Phone:509-220-3048
Mailing Address - Fax:509-279-0286
Practice Address - Street 1:922 S COWLEY ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1263
Practice Address - Country:US
Practice Address - Phone:509-220-3048
Practice Address - Fax:509-279-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7127715Medicaid
WA300815300815OtherPREMERA BLUE CROSS PROV #
WAP00260800OtherPALMETTO GBA-RAILROAD MED
WA8852383Medicare ID - Type UnspecifiedGROUP NUMBER