Provider Demographics
NPI:1134158348
Name:FISHERS LANDING URGENT & FAMILY CARE
Entity type:Organization
Organization Name:FISHERS LANDING URGENT & FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-281-7399
Mailing Address - Street 1:PO BOX 873236
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687
Mailing Address - Country:US
Mailing Address - Phone:360-882-6997
Mailing Address - Fax:360-882-4132
Practice Address - Street 1:3200 SE 164TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:360-882-6997
Practice Address - Fax:360-882-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7115348Medicaid
WA7115348Medicaid
WA6363730001Medicare NSC