Lake Wilderness Medical Clinic Llc

LBN: Lake Wilderness Medical Clinic Llc
Lake Wilderness Medical Clinic Llc is an health care organization with primary practice located at 26907 Maple Valley Black Diamond Rd Se , Maple Valley WA 98038-8314. The organization recently has only one registered license in Managed Care Organizations / Exclusive Provider Organization, which is considered as the primary health care specialty. Lake Wilderness Medical Clinic Llc can be contacted via phone (425) 432-9611, or through Jangala, Chester E via phone (425) 432-9611.

Contact Information

Primary practice address
26907 Maple Valley Black Diamond Rd Se Maple Valley WA 98038-8314
Phone: (425) 432-9611
Fax: (206) 973-5399
Website:
Map and Directions
Authorized official contact:
Name: Jangala, Chester E Doctor of Medicine (MD)
Phone: (425) 432-9611

Health care specialties

SpecialtyCodeLicense #State
Managed Care Organizations / Exclusive Provider Organization 302F00000X MD00023662 Washington

Profile Details

NPI number 1982879045
LBN Legal business name Lake Wilderness Medical Clinic Llc
DBA Doing business as
Authorized official Jangala, Chester E Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 29th, 2008
Last updated Apr 29th, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Popular Providers