Provider Demographics
NPI:1639941156
Name:UPPER COUNTY PRIMARY CARE LLC
Entity type:Organization
Organization Name:UPPER COUNTY PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:425-244-4121
Mailing Address - Street 1:PO BOX 1135
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:WA
Mailing Address - Zip Code:98941-0014
Mailing Address - Country:US
Mailing Address - Phone:509-620-5501
Mailing Address - Fax:
Practice Address - Street 1:112 W RAILROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1131
Practice Address - Country:US
Practice Address - Phone:509-620-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty