Provider Demographics
NPI: | 1821657578 |
---|---|
Name: | FAMILY CARE NETWORK, PLLC |
Entity Type: | Organization |
Organization Name: | FAMILY CARE NETWORK, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT AND PHYSICIAN |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RODNEY |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | ANDERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 360-318-8800 |
Mailing Address - Street 1: | 709 W. ORCHARD DR. |
Mailing Address - Street 2: | STE. 4 |
Mailing Address - City: | BELLINGHAM |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98225 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 360-318-8800 |
Mailing Address - Fax: | 360-318-1085 |
Practice Address - Street 1: | 2116 E. SECTION ST. |
Practice Address - Street 2: | |
Practice Address - City: | MOUNT VERNON |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98274 |
Practice Address - Country: | US |
Practice Address - Phone: | 360-428-1700 |
Practice Address - Fax: | 360-848-4350 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | FAMILY CARE NETWORK, PLLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2019-06-06 |
Last Update Date: | 2019-06-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty |