Provider Demographics
NPI:1184751638
Name:EDMONDS FAMILY CARE, PLLC
Entity type:Organization
Organization Name:EDMONDS FAMILY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUGAICHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-775-2066
Mailing Address - Street 1:6101 200TH ST SW
Mailing Address - Street 2:STE#208
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6077
Mailing Address - Country:US
Mailing Address - Phone:425-775-2066
Mailing Address - Fax:425-775-5306
Practice Address - Street 1:6101 200TH ST SW
Practice Address - Street 2:STE#208
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6077
Practice Address - Country:US
Practice Address - Phone:425-775-2066
Practice Address - Fax:425-775-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602496426261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128606Medicaid
WA0199257OtherLABOR&INDUSTRIES
WA0199257OtherLABOR&INDUSTRIES