1073687174 NPI number — WHITEHORSE FAMILY MEDICINE, INC., P.S.

Table of content: (NPI 1073687174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073687174 NPI number — WHITEHORSE FAMILY MEDICINE, INC., P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITEHORSE FAMILY MEDICINE, INC., P.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WHITEHORSE FAMILY MEDICINE
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073687174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 WESLEY ST STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98223-1668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-435-2233
Provider Business Mailing Address Fax Number:
360-435-3966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 WESLEY ST STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-1668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-435-2233
Provider Business Practice Location Address Fax Number:
360-435-3966
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TENDERING
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
360-435-2233

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7092679 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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