Provider Demographics
NPI:1265568349
Name:JOSEPH LEHIGH JENSEN III
Entity type:Organization
Organization Name:JOSEPH LEHIGH JENSEN III
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-997-2011
Mailing Address - Street 1:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-1069
Mailing Address - Country:US
Mailing Address - Phone:509-997-2011
Mailing Address - Fax:509-997-2034
Practice Address - Street 1:541 SECOND AVE
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856-1069
Practice Address - Country:US
Practice Address - Phone:509-997-2011
Practice Address - Fax:509-997-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013844261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7108756Medicaid
WA503866Medicare ID - Type UnspecifiedPROVIDER # FOR RHC