Provider Demographics
NPI:1225054141
Name:FAMILY PHYSICIANS GROUP PS
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS GROUP PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:LITVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-735-8100
Mailing Address - Street 1:312 SE STONE MILL DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-3545
Mailing Address - Country:US
Mailing Address - Phone:360-735-8100
Mailing Address - Fax:360-735-3400
Practice Address - Street 1:16811 SE MCGILLIVRAY BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-0400
Practice Address - Country:US
Practice Address - Phone:360-735-8100
Practice Address - Fax:360-735-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7984800Medicaid
WA7984800Medicaid
WAG000680200Medicare PIN