Provider Demographics
NPI:1346226362
Name:ABC PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:ABC PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:K
Authorized Official - Last Name:FARKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-534-9222
Mailing Address - Street 1:1920 BLACK LAKE BLVD SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-5651
Mailing Address - Country:US
Mailing Address - Phone:360-534-9222
Mailing Address - Fax:360-534-9223
Practice Address - Street 1:1920 BLACK LAKE BLVD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5651
Practice Address - Country:US
Practice Address - Phone:360-534-9222
Practice Address - Fax:360-534-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5711ABOtherREGENCE RIDER NUMBER
WA7121486Medicaid