Provider Demographics
NPI:1871501742
Name:WHITE RIVER FAMILY HEALTH CLINIC
Entity Type:Organization
Organization Name:WHITE RIVER FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FELIPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-735-2777
Mailing Address - Street 1:1340 M ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-6755
Mailing Address - Country:US
Mailing Address - Phone:253-735-2777
Mailing Address - Fax:253-735-4153
Practice Address - Street 1:1340 M ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-6755
Practice Address - Country:US
Practice Address - Phone:253-735-2777
Practice Address - Fax:253-735-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty