Provider Demographics
NPI:1023834439
Name:MAIN STREET FAMILY MEDICINE, PLLC
Entity type:Organization
Organization Name:MAIN STREET FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HALEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-474-5905
Mailing Address - Street 1:6000 NE 88TH ST STE D102
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0982
Mailing Address - Country:US
Mailing Address - Phone:360-474-5905
Mailing Address - Fax:360-639-8017
Practice Address - Street 1:6000 NE 88TH ST STE D102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0982
Practice Address - Country:US
Practice Address - Phone:360-474-5905
Practice Address - Fax:360-639-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265473292OtherNPI
1346742954OtherNPI
1912432584OtherNPI
1821879024OtherNPI