Provider Demographics
NPI:1942381025
Name:KEVIN W MCCURRY MD
Entity Type:Organization
Organization Name:KEVIN W MCCURRY MD
Other - Org Name:RIFFE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCCURRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-983-8990
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:MOSSYROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98564-0810
Mailing Address - Country:US
Mailing Address - Phone:360-983-8990
Mailing Address - Fax:360-983-8995
Practice Address - Street 1:745 WILLIAMS STREET
Practice Address - Street 2:
Practice Address - City:MOSSYROCK
Practice Address - State:WA
Practice Address - Zip Code:98564-0810
Practice Address - Country:US
Practice Address - Phone:360-983-8990
Practice Address - Fax:360-983-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207Q00000X
WAMD00031132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7119381Medicaid
WA7119381Medicaid
WA503862Medicare Oscar/Certification