Provider Demographics
NPI:1699811786
Name:LCRASMUSSEN, DO, P.S.C.
Entity Type:Organization
Organization Name:LCRASMUSSEN, DO, P.S.C.
Other - Org Name:SNOQUALMIE RIDGE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDSEY
Authorized Official - Middle Name:CHILDERS
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:425-957-9075
Mailing Address - Street 1:19129 SE 63RD PL
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8621
Mailing Address - Country:US
Mailing Address - Phone:425-957-9075
Mailing Address - Fax:
Practice Address - Street 1:19129 SE 63RD PL
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8621
Practice Address - Country:US
Practice Address - Phone:425-957-9075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA000P1665261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care