Provider Demographics
NPI:1033273487
Name:OAK MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:OAK MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-787-7662
Mailing Address - Street 1:201 A ST SE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1100
Mailing Address - Country:US
Mailing Address - Phone:509-787-7662
Mailing Address - Fax:
Practice Address - Street 1:201 A ST SE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1100
Practice Address - Country:US
Practice Address - Phone:509-787-7662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001372261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8145344Medicaid
WAG8855486Medicare ID - Type Unspecified
WA8145344Medicaid