Provider Demographics
NPI:1851613749
Name:CHATTAROY FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:CHATTAROY FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:509-276-2554
Mailing Address - Street 1:PO BOX 1304
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-1304
Mailing Address - Country:US
Mailing Address - Phone:509-276-2554
Mailing Address - Fax:509-276-2564
Practice Address - Street 1:23 E. CRAWFORD AVE.
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006
Practice Address - Country:US
Practice Address - Phone:509-276-2554
Practice Address - Fax:509-276-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00049372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1851613749Medicaid
WAG8893308Medicare PIN