Provider Demographics
NPI:1750456273
Name:ASSOCIATES IN FAMILY MEDICINE
Entity Type:Organization
Organization Name:ASSOCIATES IN FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-734-4404
Mailing Address - Street 1:3130 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1904
Mailing Address - Country:US
Mailing Address - Phone:360-734-4404
Mailing Address - Fax:360-734-7409
Practice Address - Street 1:3130 ELLIS ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1904
Practice Address - Country:US
Practice Address - Phone:360-734-4404
Practice Address - Fax:360-734-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207Q00000X
WA50D0699072291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7047038Medicaid
WAG001484000Medicare PIN