Provider Demographics
NPI:1679582217
Name:SALMON CREEK FAMILY PRACTICE
Entity Type:Organization
Organization Name:SALMON CREEK FAMILY PRACTICE
Other - Org Name:DBA URGENT CARE AT SALMON CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FELMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PANGANIBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-566-4700
Mailing Address - Street 1:1319 NE 134TH ST
Mailing Address - Street 2:STE 107
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2717
Mailing Address - Country:US
Mailing Address - Phone:360-566-6726
Mailing Address - Fax:360-566-4739
Practice Address - Street 1:1319 NE 134TH ST
Practice Address - Street 2:STE 107
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2718
Practice Address - Country:US
Practice Address - Phone:360-566-4700
Practice Address - Fax:360-566-4739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALMON CREEK FAMILY PRACTICE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8803665Medicare PIN