DAVID C WYNECOOP MEMORIAL CLINIC (NPI# 1003963000) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003963000 |
| Entity Type | Organization |
| Organization Name | DAVID C WYNECOOP MEMORIAL CLINIC |
| Practice Address |
6203 Agency Loop Road Wellpinit WA 99040-0357 |
| Practice Telephone | 5092584517 |
| Practice Fax Number | 5092587152 |
| Mailing Telephone | 5092584517 |
| Mailing Fax Number | 5092587152 |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | WILLIAM N WILES (ADMINISTRATIVE OFFICER) |
| Authorized Official Telephone | 5092584517 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | LICENSE | PH00052198 | 01 |
| WA | NCPDP NUMBER | 4926309 | 01 |
| WA | LICENSE | PH00044329 | 01 |
| Street Address |
6203 AGENCY LOOP ROAD |
| City | WELLPINIT |
| State | WA |
| Zip Code | 99040-0357 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457354946 | James Charles Jordan | Pharmacist | 6203 Agency Loop Road, Wellpinit, WA 99040 | 2005-05-27 |
| 1134275977 | Alma Regina Macclain | Registered Nurse | 6203 Agency Loop Road, Wellpinit, WA 99040 | 2007-01-26 |
| 1457343287 | Tracy Lee Hesler Lind | Nurse Practitioner | 6203 Agency Loop Road, Wellpinit, WA 99040 | 2005-08-18 |
| 1134125594 | Margaret Julie Koepping | Registered Nurse | 6203 Agency Loop Road, Wellpinit, WA 99040-0357 | 2005-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891339966 | Derrick Lemont Singleton | Counselor | 6233 Old School Rd, 6233 Old School Rd, Wellpinit, WA 99040 | 2019-11-01 |
| 1023652195 | Robert Joseph Hayward | Counselor | 6228 East Old School Rd, Wellpinit, WA 99040 | 2019-11-01 |
| 1033503107 | Shad Burnett St Paul | Counselor | 6228 E. Old School Rd, Wellpinit, WA 99040 | 2015-03-26 |
| 1003183427 | Kimberley J Doyle | Counselor | 6228 E Old School Rd, Wellpinit, WA 99040 | 2011-11-30 |
| 1649584665 | Lonna M Hughes | Counselor | 6228 East Old School Road, Wellpinit, WA 99040 | 2010-08-02 |
| 1083849129 | Phyllis Lorraine Grant | Counselor | 6228 Old School Rd., Wellpinit, WA 99040 | 2009-05-19 |
| 1558596775 | Jeanne Laree White | Social Worker | 6228 E. Old School Rd., Wellpinit, WA 99040 | 2009-05-18 |
| 1467644294 | Spokane Tribe of Indians | Community/Behavioral Health | 6228 E. School Road, Wellpinit, WA 99040 | 2007-08-15 |
| 1750411310 | David C Wynecoop Memorial Clinic Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Agency Square, Wellpinit, WA 99040 | 2007-03-06 |
| 1588701858 | Kathleen A Ames | Registered Nurse | 6203 Agency Loop Rd., Welllpinit, WA 99040 | 2007-01-30 |
| Find all providers in zip 99040 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| 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. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750411310 | David C Wynecoop Memorial Clinic Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Agency Square, Wellpinit, WA 99040 | 2007-03-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184135808 | Alliance Healthcare Technolgies | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1781 267th Ct Se, Sammamish, WA 98075 | 2017-10-20 |
| 1427171628 | Roger Saux Health Center | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1505 Klaookwa Drive, Taholah, WA 98587 | 2007-04-10 |
| 1265556005 | Department of Health and Human Services | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 29 Nespelem San Poil Street, Nespelem, WA 99155-0071 | 2007-03-19 |
| 1679607956 | Omak Tribal Health Clinic | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 29 Nespelem Sanpoil St, Nespelem, WA 99155-0071 | 2007-03-16 |
| 1063542645 | Colville Indian Health Center Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Agency Campus Hwy 155, Nespelem, WA 99155 | 2007-03-06 |
| 1487105482 | Native Project Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1803 W Maxwell Ave, Spokane, WA 99201-2831 | 2016-10-14 |
| 1881142214 | Confederated Tribes of The Chehalis Reservation | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 21 Niederman Rd, Oakville, WA 98568-8904 | 2016-09-14 |
| 1699184366 | The Native Project | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1803 W Maxwell Ave, Spokane, WA 99201-2831 | 2014-08-07 |
| 1952623027 | Nisqually Indian Tribe | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 4816 She Nah Num Dr Se, Olympia, WA 98513-9105 | 2010-02-17 |
| 1225241581 | Muckleshoot Health and Wellness Center Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 17500 Se 392nd St, Attn Pharmacy, Auburn, WA 98092-9705 | 2007-05-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.