Provider Demographics
NPI:1356514665
Name:HEALTHY FUTURE PEDIATRICS
Entity type:Organization
Organization Name:HEALTHY FUTURE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BUFFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-528-4220
Mailing Address - Street 1:300 LILLY RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5428
Mailing Address - Country:US
Mailing Address - Phone:360-528-4220
Mailing Address - Fax:360-528-4226
Practice Address - Street 1:300 LILLY RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5428
Practice Address - Country:US
Practice Address - Phone:360-528-4220
Practice Address - Fax:360-528-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2010-06-22
Deactivation Date:2008-06-30
Deactivation Code:
Reactivation Date:2010-06-22
Provider Licenses
StateLicense IDTaxonomies
WAMD00027556208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128853Medicaid
WA8119364Medicaid
WA9646134Medicaid
WA9649971Medicaid