Provider Demographics
NPI:1922189521
Name:NORTH PINES FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:NORTH PINES FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-926-1531
Mailing Address - Street 1:12704 E NORA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:509-926-0956
Practice Address - Street 1:12704 E NORA AVE STE B
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1140
Practice Address - Country:US
Practice Address - Phone:509-926-1531
Practice Address - Fax:509-926-0956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005435163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9641226Medicaid
WAGAB39847Medicare PIN