Provider Demographics
NPI:1831674472
Name:PACIFIC NORTHWEST FAMILY CARE
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DBA, ARNP, FNP-BC
Authorized Official - Phone:253-686-1766
Mailing Address - Street 1:325 WASHINGTON AVE S STE 135
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5767
Mailing Address - Country:US
Mailing Address - Phone:206-582-8186
Mailing Address - Fax:
Practice Address - Street 1:4300 TALBOT RD S STE 103
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6238
Practice Address - Country:US
Practice Address - Phone:253-686-1766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-29
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty