Provider Demographics
NPI:1225217888
Name:CHARLES E KRAUSE MD
Entity Type:Organization
Organization Name:CHARLES E KRAUSE MD
Other - Org Name:APPLE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-946-2340
Mailing Address - Street 1:750 SWIFT BLVD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3521
Mailing Address - Country:US
Mailing Address - Phone:509-946-2340
Mailing Address - Fax:
Practice Address - Street 1:750 SWIFT BLVD
Practice Address - Street 2:SUITE 22
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3521
Practice Address - Country:US
Practice Address - Phone:509-946-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8859734OtherMEDICARE GROUP NUMBER
8859735OtherMEDICARE INDIVIDUAL NUMBE
WA=========Medicaid
G8859734OtherMEDICARE GROUP NUMBER
A07267Medicare UPIN