Provider Demographics
NPI:1235349051
Name:EVAN H. HIRSCH, M.D., INC., P.S.
Entity Type:Organization
Organization Name:EVAN H. HIRSCH, M.D., INC., P.S.
Other - Org Name:HIRSCH HOLISTIC FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-464-9965
Mailing Address - Street 1:3525 ENSIGN RD NE
Mailing Address - Street 2:SUITE N
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-464-9965
Mailing Address - Fax:888-406-8040
Practice Address - Street 1:3525 ENSIGN RD NE
Practice Address - Street 2:SUITE N
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-464-9965
Practice Address - Fax:888-406-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046712261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care