Provider Demographics
NPI:1922284215
Name:BAYVIEW FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:BAYVIEW FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, ARNP
Authorized Official - Phone:425-355-5700
Mailing Address - Street 1:631 5TH ST
Mailing Address - Street 2:#100
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1581
Mailing Address - Country:US
Mailing Address - Phone:425-355-5700
Mailing Address - Fax:425-355-5722
Practice Address - Street 1:631 5TH ST
Practice Address - Street 2:#100
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-1581
Practice Address - Country:US
Practice Address - Phone:425-355-5700
Practice Address - Fax:425-355-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9653668Medicaid
WA9653668Medicaid