Provider Demographics
NPI:1881859601
Name:COMPREHENSIVE FAMILY CARE PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE FAMILY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-765-1602
Mailing Address - Street 1:821 E BROADWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837
Mailing Address - Country:US
Mailing Address - Phone:509-765-1602
Mailing Address - Fax:
Practice Address - Street 1:821 E BROADWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837
Practice Address - Country:US
Practice Address - Phone:509-765-1602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1125855Medicaid
WA1125855Medicaid