Provider Demographics
NPI:1568406601
Name:ANACORTES HEALTH CARE PS
Entity Type:Organization
Organization Name:ANACORTES HEALTH CARE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-588-9343
Mailing Address - Street 1:1220 22ND ST
Mailing Address - Street 2:STE A
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2582
Mailing Address - Country:US
Mailing Address - Phone:360-588-9343
Mailing Address - Fax:
Practice Address - Street 1:1220 22ND ST
Practice Address - Street 2:STE A
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2582
Practice Address - Country:US
Practice Address - Phone:360-588-9343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8853941Medicare ID - Type Unspecified