Lake Wilderness Medical Clinic LLC
Lake Wilderness Medical Clinic LLC is an Exclusive Provider Organization in Maple Valley, Washington. Licensed in Washington. Registered with an NPI since 2008.
- Licensed in
- WA
- In the registry since
- 2008
What do these letters mean?
- LLC — Limited liability company
- A form of business registration, not a clinical qualification.
Practice location Address checks out
26907 Maple Valley Black Diamond Rd SEMaple Valley, WA 98038-8314
Phone: (425) 432-9611
Fax: (206) 973-5399
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Exclusive Provider Organization (primary) | Taxonomy 302F00000X · Licence MD00023662 (WA) |
|---|
Record details
| NPI number | 1982879045 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Chester Jangala — Physician · (425) 432-9611 |
| NPI enumerated | April 29, 2008 |
| Last updated in NPPES | April 29, 2008 |
| Mailing address | Po Box 1142, Ravensdale, WA 98051-1142 |