Provider Demographics
NPI:1558567222
Name:HARBOR FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:HARBOR FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-875-5339
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586-0227
Mailing Address - Country:US
Mailing Address - Phone:360-875-5339
Mailing Address - Fax:360-875-5042
Practice Address - Street 1:800 ALDER ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98586
Practice Address - Country:US
Practice Address - Phone:360-875-5339
Practice Address - Fax:360-875-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7087810Medicaid
WAHI4845OtherREGENCE BLUE SHIELD
WAA08237Medicare UPIN
WA7087810Medicaid