Provider Demographics
NPI:1669742714
Name:B FIT PREVENTIVE CARE CLINIC
Entity type:Organization
Organization Name:B FIT PREVENTIVE CARE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BOLEY
Authorized Official - Suffix:II
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-642-7246
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-1447
Mailing Address - Country:US
Mailing Address - Phone:360-642-7246
Mailing Address - Fax:
Practice Address - Street 1:1715 PACIFIC AVE N
Practice Address - Street 2:SUITE B
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-3604
Practice Address - Country:US
Practice Address - Phone:360-642-7246
Practice Address - Fax:360-642-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain