Provider Demographics
NPI:1417036849
Name:ORCHARDS FAMILY MEDICINE, INC. PS
Entity Type:Organization
Organization Name:ORCHARDS FAMILY MEDICINE, INC. PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:LEAF
Authorized Official - Last Name:LELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-567-0488
Mailing Address - Street 1:9300 NE VANCOUVER MALL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-8206
Mailing Address - Country:US
Mailing Address - Phone:360-567-0488
Mailing Address - Fax:360-567-0489
Practice Address - Street 1:9300 NE VANCOUVER MALL DR STE 201
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-8206
Practice Address - Country:US
Practice Address - Phone:360-567-0488
Practice Address - Fax:360-567-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-05
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60285535103T00000X
WAMD00044580207Q00000X
WAP0515213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR838530000OtherREGENCE BLUE CROSS GROUP
G8854330Medicare ID - Type Unspecified