Provider Demographics
NPI:1891901971
Name:FIRCREST FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:FIRCREST FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DELINDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHAWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-564-7701
Mailing Address - Street 1:1339 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6552
Mailing Address - Country:US
Mailing Address - Phone:253-564-7701
Mailing Address - Fax:253-565-4688
Practice Address - Street 1:1339 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6552
Practice Address - Country:US
Practice Address - Phone:253-564-7701
Practice Address - Fax:253-565-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601996685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1649558479OtherNPI
WA1518150119OtherNPI
WA1649558479OtherNPI