1912900234 NPI number — FAMILY CARE NETWORK, PLLC

Table of content: (NPI 1912900234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912900234 NPI number — FAMILY CARE NETWORK, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY CARE NETWORK, 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:
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:
1912900234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
709 W. ORCHARD
Provider Second Line Business Mailing Address:
STE. 4
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-318-8800
Provider Business Mailing Address Fax Number:
360-318-1085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2116 E. SECTION ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-428-1700
Provider Business Practice Location Address Fax Number:
360-848-4312
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HIPSKIND
Authorized Official First Name:
MARCY
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-318-8800

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  602079976 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1300X , with the licence number: 602079976 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GAB19758 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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