Provider Demographics
NPI:1568658441
Name:ANDERT FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:ANDERT FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ANDERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:509-946-3700
Mailing Address - Street 1:915 GOETHALS DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3527
Mailing Address - Country:US
Mailing Address - Phone:509-946-3700
Mailing Address - Fax:509-946-3862
Practice Address - Street 1:915 GOETHALS DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3527
Practice Address - Country:US
Practice Address - Phone:509-946-3700
Practice Address - Fax:509-946-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0041967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7131105Medicaid
WAH74200Medicare UPIN
WA7131105Medicaid