Provider Demographics
NPI:1225163926
Name:R & B FLECK ENTERPRISES, LLC
Entity Type:Organization
Organization Name:R & B FLECK ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FLECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-520-1794
Mailing Address - Street 1:1365 BEET RD
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-7180
Mailing Address - Country:US
Mailing Address - Phone:509-520-1794
Mailing Address - Fax:509-529-5860
Practice Address - Street 1:1365 BEET RD
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-7180
Practice Address - Country:US
Practice Address - Phone:509-520-1794
Practice Address - Fax:509-529-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA252090019815208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1328202Medicaid
WAG8803274OtherMEDICARE ID GROUP NUMBER
WA1578629226OtherINDIVIDUAL NPI #
WA7121478Medicaid
WAG8803274OtherMEDICARE ID GROUP NUMBER
WA8803276Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER