Provider Demographics
NPI:1861634479
Name:EDWIN STICKLE GROUP, INC.
Entity Type:Organization
Organization Name:EDWIN STICKLE GROUP, INC.
Other - Org Name:FIRST STOP CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-820-3789
Mailing Address - Street 1:638 SUNSET PARK DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1546
Mailing Address - Country:US
Mailing Address - Phone:360-421-5588
Mailing Address - Fax:360-671-5725
Practice Address - Street 1:1815 MAIN ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9454
Practice Address - Country:US
Practice Address - Phone:360-778-1580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty