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MARYS CORNER MEDICAL CLINIC INC. PS
NPI 1104016138
Clinic/Center - Rural Health in Chehalis, WA

Active since July 26, 2007CLIA 50D1013243 · Microscopy
4254 JACKSON HIGHWAY, CHEHALIS, WA 98532(360) 262-3966(360) 262-3967 Get Directions Write a Review

NPPES record last updated: April 26, 2012. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Marys Corner Medical Clinic Inc. Ps NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARYS CORNER MEDICAL CLINIC INC. PS (NPI 1104016138) is a healthcare organization registered as a rural health in Chehalis, Washington and active in the NPI registry since July 2007. The organization holds a CLIA Microscopy certificate valid through April 4, 2028 and lists Kimberly H Inglis, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1104016138
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameMARYS CORNER MEDICAL CLINIC INC. PS
Location Address4254 JACKSON HIGHWAYChehalis, WA 98532
Mailing Address4254 Jackson HighwayChehalis, WA 98532 · (360) 262-3966 · Fax (360) 262-3967
Phone(360) 262-3966
Fax(360) 262-3967
Organization SubpartNo
Authorized OfficialKimberly H InglisOffice Manager · (360) 262-3966
Enumeration DateJuly 26, 2007
Last NPPES UpdateApril 26, 2012
✔ NPI 1104016138 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
Also ListedFamily MedicineTaxonomy 207Q00000X · License MD00039760 (WA)
Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X · License PA10004588 (WA)
4254 JACKSON HIGHWAY, Chehalis, WA 98532
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Other Identifiers 6

Medicaid7132244WA
Medicaid7132764WA
Medicare OSCAR/certification503898WA
Medicare PING8875791WA
Medicare PINGAB37576WA
Medicaid1117829WA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 50D1013243

Marys Corner Medical Clinic Inc Ps · Chehalis, WA
Active · expires Apr 4, 2028
CLIA Number50D1013243
Laboratory TypeRural Health Clinic
Certificate Effective DateDecember 15, 2003
Certificate Expiration DateApril 4, 2028
Laboratory DirectorRobert D. Mcelhaney, Jr, MD
Laboratory Phone(360) 262-3966
Laboratory LocationMarys Corner Medical Clinic Inc Ps4254 Jackson Hwy, Chehalis, WA 98532
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions

What is MARYS CORNER MEDICAL CLINIC INC. PS's NPI number?

The NPI number assigned to this healthcare provider is 1104016138, enumerated as an "organization" on July 26, 2007.

Where is the provider located?

The provider is located at 4254 JACKSON HIGHWAY CHEHALIS, WA 98532 and the phone number is (360) 262-3966.

What is the provider's specialty?

Clinic/Center with taxonomy code 261QR1300X and a focus in Rural Health.

What insurance does MARYS CORNER MEDICAL CLINIC INC. PS accept?

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.