1114010535 NPI number — FAMILY MEDICINE ASSOCIATES, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114010535 NPI number — FAMILY MEDICINE ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY MEDICINE ASSOCIATES, PLLC
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:
Provider Other Organization Name Type Code:
6
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:
1114010535
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:
3080 148TH AVE SE
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98007-6420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-378-8190
Provider Business Mailing Address Fax Number:
425-649-1523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3080 148TH AVE SE
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007-6420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-378-8190
Provider Business Practice Location Address Fax Number:
425-649-1523
Provider Enumeration Date:
09/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
APPELBAUM
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MANAGEING PARTNER
Authorized Official Telephone Number:
425-378-8190

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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: 0160886 . This is a "LABOR & INDUSTRY NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7112543 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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