Provider Demographics
NPI:1114010535
Name:FAMILY MEDICINE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES, PLLC
Other - Org Name:OVERLAKE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGEING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:APPELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-378-8190
Mailing Address - Street 1:3080 148TH AVE SE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-6420
Mailing Address - Country:US
Mailing Address - Phone:425-378-8190
Mailing Address - Fax:425-649-1523
Practice Address - Street 1:3080 148TH AVE SE
Practice Address - Street 2:SUITE 115
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-6420
Practice Address - Country:US
Practice Address - Phone:425-378-8190
Practice Address - Fax:425-649-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0160886OtherLABOR & INDUSTRY NUMBER
WA7112543Medicaid
WA7112543Medicaid