Provider Demographics
NPI:1700815966
Name:YAKIMA PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:YAKIMA PRIMARY CARE, PLLC
Other - Org Name:PAUL E. EMMANS JR., DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:EELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-966-5542
Mailing Address - Street 1:118 S 2ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1308
Mailing Address - Country:US
Mailing Address - Phone:509-698-3571
Mailing Address - Fax:509-698-3572
Practice Address - Street 1:118 S 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1308
Practice Address - Country:US
Practice Address - Phone:509-698-3571
Practice Address - Fax:509-698-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7056898Medicaid
WA7056898Medicaid
WAGAB33468Medicare PIN