Provider Demographics
NPI:1326013996
Name:ADVANCED FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:ADVANCED FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-453-6838
Mailing Address - Street 1:2007 152ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5521
Mailing Address - Country:US
Mailing Address - Phone:425-453-6838
Mailing Address - Fax:425-456-0106
Practice Address - Street 1:2007 152ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5521
Practice Address - Country:US
Practice Address - Phone:425-453-6838
Practice Address - Fax:425-456-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7087455Medicaid
WA7087455Medicaid