Provider Demographics
NPI:1073687174
Name:WHITEHORSE FAMILY MEDICINE, INC., P.S.
Entity Type:Organization
Organization Name:WHITEHORSE FAMILY MEDICINE, INC., P.S.
Other - Org Name:WHITEHORSE FAMILY MEDICINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TENDERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-435-2233
Mailing Address - Street 1:875 WESLEY ST STE 250
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1668
Mailing Address - Country:US
Mailing Address - Phone:360-435-2233
Mailing Address - Fax:360-435-3966
Practice Address - Street 1:875 WESLEY ST STE 250
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1668
Practice Address - Country:US
Practice Address - Phone:360-435-2233
Practice Address - Fax:360-435-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7092679Medicaid
WA7092679Medicaid