Provider Demographics
NPI:1235377987
Name:ALPINE LAKES FAMILY PRACTICE, PLLC
Entity Type:Organization
Organization Name:ALPINE LAKES FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-674-5344
Mailing Address - Street 1:112 W RAILROAD ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-1131
Mailing Address - Country:US
Mailing Address - Phone:509-674-5344
Mailing Address - Fax:509-674-5704
Practice Address - Street 1:112 W RAILROAD ST
Practice Address - Street 2:SUITE #200
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1131
Practice Address - Country:US
Practice Address - Phone:509-674-5344
Practice Address - Fax:509-674-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002272261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA151431Medicare UPIN