Provider Demographics
NPI:1114263225
Name:DAVID C. WYNECOOP, MEMORIAL CLINIC
Entity Type:Organization
Organization Name:DAVID C. WYNECOOP, MEMORIAL CLINIC
Other - Org Name:WELLPINIT INDIAN HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:DELAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-258-4517
Mailing Address - Street 1:928 E ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2637
Mailing Address - Country:US
Mailing Address - Phone:509-258-4517
Mailing Address - Fax:509-258-6757
Practice Address - Street 1:928 E ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2637
Practice Address - Country:US
Practice Address - Phone:509-258-4517
Practice Address - Fax:509-258-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00147960313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility