Provider Demographics
NPI:1255916425
Name:MOXEE MEDICAL CLINIC
Entity type:Organization
Organization Name:MOXEE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTHINI
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-948-2252
Mailing Address - Street 1:1024 BEANE RD
Mailing Address - Street 2:
Mailing Address - City:MOXEE
Mailing Address - State:WA
Mailing Address - Zip Code:98936-9750
Mailing Address - Country:US
Mailing Address - Phone:509-948-2252
Mailing Address - Fax:
Practice Address - Street 1:301 W PROSPECT RD STE F1
Practice Address - Street 2:
Practice Address - City:MOXEE
Practice Address - State:WA
Practice Address - Zip Code:98936-9811
Practice Address - Country:US
Practice Address - Phone:509-902-8244
Practice Address - Fax:509-902-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care