Provider Demographics
NPI:1376268680
Name:AUSINK FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:AUSINK FAMILY MEDICINE PC
Other - Org Name:AUSINK FAMILY MEDICINE AND WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:AUSINK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:509-698-2520
Mailing Address - Street 1:105 W ORCHARD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1329
Mailing Address - Country:US
Mailing Address - Phone:509-698-2520
Mailing Address - Fax:509-698-2558
Practice Address - Street 1:105 W ORCHARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1329
Practice Address - Country:US
Practice Address - Phone:509-698-2520
Practice Address - Fax:509-698-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604968950OtherBUSINESS LICENSE