Provider Demographics
NPI:1235695883
Name:AMG PRIMARY HEALTHCARE LLC
Entity Type:Organization
Organization Name:AMG PRIMARY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARRIGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-943-8839
Mailing Address - Street 1:344 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:WA
Mailing Address - Zip Code:99323-9635
Mailing Address - Country:US
Mailing Address - Phone:509-727-6891
Mailing Address - Fax:509-943-8851
Practice Address - Street 1:303 BRADLEY BLVD STE 202
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4497
Practice Address - Country:US
Practice Address - Phone:509-943-8839
Practice Address - Fax:509-943-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty