Provider Demographics
NPI:1528227501
Name:L. G. STECK MEMORIAL CLINIC, P. S.
Entity Type:Organization
Organization Name:L. G. STECK MEMORIAL CLINIC, P. S.
Other - Org Name:BIG ROCK HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BREDESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-740-4001
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:NAPAVINE
Mailing Address - State:WA
Mailing Address - Zip Code:98565-0418
Mailing Address - Country:US
Mailing Address - Phone:360-357-8822
Mailing Address - Fax:360-357-8823
Practice Address - Street 1:6342 LITTLEROCK RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7332
Practice Address - Country:US
Practice Address - Phone:360-357-8822
Practice Address - Fax:360-357-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty