Provider Demographics
NPI:1770791816
Name:FAMILY PHYSICIANS GENERAL CLINIC
Entity type:Organization
Organization Name:FAMILY PHYSICIANS GENERAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-444-6533
Mailing Address - Street 1:12459 AMBAUM BLVD SW STE A
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2660
Mailing Address - Country:US
Mailing Address - Phone:206-444-6533
Mailing Address - Fax:206-439-0421
Practice Address - Street 1:12459 AMBAUM BLVD SW STE A
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-2660
Practice Address - Country:US
Practice Address - Phone:206-444-6533
Practice Address - Fax:206-439-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021620208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50D0944376OtherCLIA
WASP8107OtherREGENCE
WA122873OtherL AND I
WA7113020Medicaid
WA122873OtherL AND I