Provider Demographics
NPI:1407229719
Name:RIDGEFIELD FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:RIDGEFIELD FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-887-9494
Mailing Address - Street 1:8507 S 5TH ST
Mailing Address - Street 2:SUITE 113
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-3421
Mailing Address - Country:US
Mailing Address - Phone:360-887-9494
Mailing Address - Fax:360-887-9498
Practice Address - Street 1:8507 S 5TH ST
Practice Address - Street 2:SUITE 113
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-3421
Practice Address - Country:US
Practice Address - Phone:360-887-9494
Practice Address - Fax:360-887-9498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8856198Medicare PIN